On covering one's mouth (when yawning)

BMJ 2004; 328 doi: (Published 15 April 2004) Cite this as: BMJ 2004;328:963
  1. George Dunea, attending physician
  1. Cook County Hospital, Chicago, USA

    A simple observational study recently found that 67.5% of medical students attending morning conference did not cover their mouth while yawning.

    The data are still with the statisticians, who raised several problems. Could the extreme boredom of attending these conferences have induced excessive yawning and biased the results? Were genders and races adequately represented in the study? Can the results be extrapolated to livelier conferences? Was there a distinction drawn between the students on call the night before and those partying only until 2 am? And was the study adequately powered to yield a meaningful result?

    There were legal issues. Was the study conducted under a valid approved protocol? There was indeed an old one, but it had expired two weeks earlier. The older study had been approved only for 50 subjects, and now 55 had been studied, a misdemeanour that may have to be reported to the federal watchdogs. The consent form was also inadequate, written in legalese, so that no medical student could possibly understand it.

    It was also unfortunate that no preliminary review of the literature had been done. Imagine spending precious resources only to find out later that an identical study had already appeared in an important publication such as the Journal of Uvula Deformity.

    Indeed the ethics committee was a main sticking point. It felt that students were a captive audience and that their privacy had been violated. Would the outcome influence their end of term evaluations? One member of the committee thought that the results should be placed in a locked box and never be published.

    There was also inadequate bacteriological input. Was it better to contaminate the palm of the hand with bacteria rather than blow them into the atmosphere? What about budding deans and other medical politicians, doomed to be always shaking hands?

    It was concluded that the study smacked of elitism and health fascism. For tonsils are sometimes less unsightly than elbows. And exposing one's uvula in public may be no worse than baring one's ankles and knees.