What Do Washing Your Hands and Voting Have in Common?

Oct. 26, 2006 — -- Every flu season, doctors pound this mantra into our heads: The best way to prevent cold and flu is to wash your hands.

But "Freakonomics" co-author Stephen Dubner says that doctors are actually the worst offenders of the hand-washing rule.

"A whole raft of medical studies have shown that hospital personnel wash or disinfect their hands in fewer than half the instances they should," Dubner said. "And doctors are the worst offenders, more lax than either nurses or aides."

While that may seem inconceivable, Dubner says that we all sometimes believe we are much better at doing things than we actually are.

One study asked doctors to report their hand washing, and they put it at right about 73 percent -- about three out of four times.

But when these same doctors were actually observed, their actual rate was a really lousy 9 percent.

"That's a real perception gap," Dubner said.

So if doctors know they're supposed to wash their hands but don't, how can you make them change their behavior?

Cedars-Sinai Hospital in Los Angeles confronted the problem. First, it tried the corporate approach -- meetings and memos. That did almost nothing.

Next, it had people roam the hallways and give out $10 Starbucks gift certificates to doctors found washing their hands.

A doctor making hundreds of thousands of dollars a year doesn't really need free coffee that badly. Still, hand-washing rates improved -- but not enough.

Finally, an epidemiologist had the doctors put their hands on a petri dish. She took it to the lab, grew out the cultures, and photographed it.

"It turned out all the top doctors had tons of horrible bacteria on their hands," Dubner said. "Theytook one photo and turned it into a screen saver and put it on every computer in the hospital."

The result? The hand-washing rate shot up to nearly 100 percent and stayed there.

"Sometimes it's not the data. It's about how it's presented," Dubner said. "In this case, it came out of left field, and it's a reminder that big fancy programs and rewards or threats don't work."

What Does Hand Washing Have to Do With Voting?

Similarly, we all know we should vote, but only around half of Americans actually do it.

One complaint is that it's a hassle to go to the polling place, stand in line, and so on.

It seems the logical answer would be to make voting easier.

Not so, Dubner says. In fact, there is some evidence that the opposite is true.

Switzerland, where people vote enthusiastically on almost everything, suffered a small drop in voter turnout. Officials there decided they'd try to make it easier by mailing ballots to people's homes.

The result: Voting rates actually declined, especially in small towns and rural areas.

"It turns out that one of the big reasons people vote is to have their friends and neighbors see them vote," Dubner said. "When you take that away, people don't vote as much."

Some economists actually argue that voting is for suckers.

"The argument made by traditional economists is that voting exacts a cost in time, effort, lost productivity and possibly wages, and has no discernable payoff except some vague sense of having done your 'civic duty,'" Dubner said.

Economists, however, are sometimes accused of knowing the worth of everything and the value of nothing.

"One of the themes of 'Freakonomics' is that there are economic incentives that are not monetary, and having a clean conscience is one incentive that drives people strongly," Dubner said.

His advice: Go ahead and vote.

"But make sure to wash your hands afterwards, cause those levers and touch screens get as filthy as doctors' hands," he said.