In 1847, maternal mortality from childbirth in a Hungarian clinic was approximately 18%. A second clinic that offered maternity services had numbers much nearer to 2%. Women begged for admission to the second clinic in order to avoid puerperal fever, the name of the illness associated with such significant death rates. At the First Clinic, medical students and physicians routinely performed autopsies as well as patient services, including maternity services. At the Second Clinic, midwives did delivery and did not participate in any autopsies. Following the death of a colleague who became sick with puerperal fever after being stuck with an autopsy scalpel, a physician named Ignaz Semmelweis inferred that cadaveric particles must cause puerperal fever, and that students and physicians were transferring them to mothers after doing autopsies. After instituting the practice of handwashing in the First Clinic, the mortality dropped from 18.3% in April of 1847 to 1.9% in August that same year.
The results of Semmelweis' observations lead to the realization that it was bacteria, not cadaver particles, that caused puerperal fever. The far-reaching consequences were the development of the germ theory of disease, and the eventual wide-spread practice of using sterile technique in any invasive procedure in order to prevent serious infection. From an operating room to simple bedside procedures, doctors and nurses everywhere observe sterile technique, which involves sterilizing the patient's skin with antiseptic solution, then donning a sterile gown and gloves, and finally draping the patient with a sterile cloth to cover all non-sterile areas and leave exposed only the area to be worked on.
This "sterile field" is a means of a barrier to prevent infection. It isn't the only "sterile" field, though. In some ways, most every patient encounter is "sterile" to some degree. A doctor must always remember to keep the doctor-patient relationship professional, cordial, and appropriately distanced. For many doctors this may be hard, as most of us want to care for our patients. Many situations that patients end up in though require much much more than we can give them; patients with terminal illness may require emotional provisions that we cannot give without breaching what would be considered "professional", and patients with difficult social situations may require much more than professional advice and assistance. The old saying "give them an inch and they'll take a mile" rings loud and true with some particularly needy patients. It is unfortunate, and hard, but necessary.
Helping someone often involves avoiding getting into the same dirt that they are. Pulling someone out of a hole tends to involve keeping yourself out of the same pit. There is a fine line though, between being far too distanced from the care of the patient and far too involved in a patient's situation, to the detriment of your own personal life. To protect themselves, doctors tend to need to use their "sterile field" of a clinic office, an organized patient encounter with clear goals of therapy and their role in a patient's health, and avoiding trying to go farther than what their role dictates. It doesn't mean that a doctor should not go to great lengths for a patient, just to remember to keep the appropriate professional as well as mental and emotional relationships with patients.
