Failure to communicate

National | Hospitals pledge to start admitting mistakes, doctors warn against taking herbal medicines before surgery, and a study links noise and hearing loss

Issue: "More than a warlord," July 21, 2001

Hospitals for honesty
Rick Hendrick went to a Chicago emergency room complaining of hives and found his cure was worse than his problem. He said hospital staffers gave him an antibiotic intended for somebody else and didn't admit the mistake. As a result, he had severe heart palpitations, nearly passed out, and was weak for several days from the drug. Mr. Hendrick said the hospital should have "come to me and said, 'This is what happened. I'm sorry, we made a terrible mistake,'" and then warned him of the side effects. A group of 5,000 hospitals across America aims to stave off such disasters with a new policy: Anytime something goes wrong with a patient's treatment, hospitals must tell the patient. If a hospital doesn't do so when a doctor gives the wrong drug or the wrong dose, it could lose its credentials. The Joint Commission on Accreditation of Healthcare Organizations announced this policy in response to a 1999 Institute of Medicine report estimating that medical errors kill 44,000 to 98,000 hospital patients each year. "We need to create a culture of safety in hospitals," said Dr. Dennis O'Leary, the group's president. The group also requires members to "initiate specific efforts to prevent medical errors." Some hospitals, including the nation's Veterans Affairs facilities, already tell patients when errors occur. The American Hospital Association, which represents 5,000 hospitals and health care systems nationwide, is even stricter: Hospitals must tell patients even about mistakes that don't cause any harm. When herbs are deadly
Herbal medicines may or may not be good for you, but they might be dangerous if taken before surgery. That's the warning from University of Chicago doctors who issued guidelines urging patients to stop taking the pills prior to a procedure. Drs. Michael Ang-Lee, Jonathan Moss, and Chun-Su Yuan write in the Journal of the American Medical Association about concerns with eight popular products: echinacea, ephedra, garlic, gingko biloba, ginseng, kava, St. John's wort, and valerian. They say complications can be serious: Gingko biloba caused a gall bladder surgery patient to develop serious bleeding. Medicinal garlic caused spinal bleeding in another, who needed a second operation to prevent paralysis. "We suspect that these cases represent only a small fraction of the actual adverse events related to herbal medications since there is no adequate reporting mechanism," they write. The doctors estimate that about half of all patients going into surgery are using some form of herbal treatment. They urge physicians to question aggressively patients about what they have taken and decide if the products can cause problems. The American Society of Anesthesiologists has its own warning that patients stop taking herbs at least two to three weeks before surgery to avoid complications. If that isn't possible, the group suggests that people even bring their medications with them to the hospital so the anesthesiologist can be informed. The warning stresses that "natural" products are not necessarily safe and that seven out of 10 patients don't tell their doctors what they are taking. Loud and dangerous
Hey, kid! Turn that music down! A government report finds 5.2 million American youngsters have some degree of hearing loss due to noise. Causes include rock concerts, fireworks, and lawn mowers. Use earplugs, recommends the Centers for Disease Control and Prevention in the journal Pediatrics. Researchers studied 5,249 participants looking for NITS, noise-induced hearing threshold shifts. They ran tests of the ability to hear certain decibels and pitches. When the results are graphed, NITS show up at distinct notches. "We need to push for children to wear hearing protection during noisy activities because NITS is entirely preventable," Amanda Niskar, a CDC nurse-epidemiologist said. Noise generated by everything from heavy machinery to musical instruments can lead to permanent loss. The study found that 4.9 percent (or 250,000 young people) have moderate to profound NITS, which may mean permanent damage. It did not show how many have simply temporary problems. The American Academy of Family Physicians reported last year that as many as 10 million Americans have some sort of noise-induced hearing loss. The group says it is a slow, usually painless process. Symptoms like ringing of the ears may appear, but they go away after a few hours. Culprits can be as common as personal stereos and loud toys. Yet once the damage is done, according to the AAFP, it can't be reversed even with hearing aids.

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