My mother always used to tell us, “Put on clean underwear before you go out, just in case you're in an accident and the doctors have to cut your clothes off.” The advice has stuck, though my own experience in the ER suggests they cut your underwear off, too, and it happens so fast your drawers have to be pretty terrible for anyone to notice.

Judging from the way some people present for their radiology appointments, however, I have to wonder what their parents told them.

I am constantly amazed at the contrast between what people expect from the healthcare system and those who staff it and what consumers and the government actually provide. Hospitals are vigilant to an extreme when it comes to cleanliness and antisepsis, yet patients who obviously have the means and good sense to know better will come for an exam filthy. It is considered unseemly to tell them to go home, bathe, and come back, so everyone around them must suffer. When they're gone, the memory of them literally lingers for hours.

Given the loose definition of patient hygiene, the recent decision by the powers-that-be to no longer pay for treatment for hospital- acquired infections, which is any infection not documented on admission, has some patients hopping on opportunity.

“Mom, can I take a bath before bed?” “No, Tommy. I told you no baths for a week. You're having your tonsils out Friday. The government says if you get an infection while you're in for surgery, everything is free. We have to get the odds in our favor.”

The way we handle methicillinresistant Staphylococcus aureus patients is another sign of this double standard. Many patients are embarrassed by the extreme measures we use in the hospital to isolate them from us and our equipment. Others seem to relish the special treatment.

“Dad, what's MRSA?” “Well, Jim, it's a little bug. The hospital says your mama has it.” “Why do we always say we have MRSA when we go to the hospital?” “It's kind of like a VIP pass. Remember when your mama learned she wasn't fat, she has obesity, and she got a free scooter and the special parking pass?” “Sure.” “Well, MRSA is a bonus on the pass, like finding your favorite toy on the sale table. You get to ride everywhere in a wheelchair, and you get special rooms with extra-quick service. It makes going to the hospital ER for your cold quick and easy.”

The amazing thing is that these infectious demons walk out our doors and go right back to unrestricted jobs handling plates, teaching kids, and stocking the grocery store, buggifying places we all go when we leave work. Calling MRSA a hospitalacquired infection is ridiculous. Not paying for its treatment is just another way of shifting cost onto the backs of providers.

I'm no fan of antiseptic sprays. They smell and tend to aggravate my throat. Unfortunately, the only recourse after some patients leave is to blast the room like a flame thrower. For the next two hours, patients and staff working in or near the room get to breathe lethal fumes because someone chose to be rude.

I have no problem caring for downtrodden souls. A good friend taught me years ago to constantly remind myself, “There, but for the grace of God, go I.” But there is a difference between downtrodden and slovenly.

At the risk of sounding a lot like my father, it saddens me sometimes to see the continued downward spiral of U.S. social standards, when rudeness, lack of simple common courtesy, and hygiene so poor that it offends those around you are considered your rights. I wonder what our Founding Mothers would think.