When the patient complains

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She was having surgery the next day and the instructions from the hospital said someone would call the night before to tell her exactly what time the surgery would be. Kristin Baird, a national consultant with the Baird Group on the patient experience and customer satisfaction in health care, waited by the phone that evening… and waited… and waited.

She called the hospital, got cut off, called again, was told to call another number, called and listened to the phone ring over and over before being disconnected. Finally, after half an hour of trying, she reached a live person who took her number and promised to call back.

On her blog this week, Baird describes her frustration: “At that point, I was not only irritated, but I had lost trust in the organization. After all, if it couldn’t answer a simple question, or even answer the phone number I was told to call, how reliable could its staff be in cutting me open and doing the right procedure on the right body part?”

What should the patient do in this situation – complain to someone in charge or keep quiet?

Chances are, most people would say nothing, even when there are valid grounds for complaining. Researchers in Sweden who randomly surveyed 1,500 adults found that fewer than 3 percent filed a formal complaint after something went wrong with their care – but among those who didn’t complain, 18.5 percent felt they had good cause to do so.

The study was published last week in BMJ Open and demonstrates what the authors called “the tip of the iceberg” when it comes to dissatisfied patients: that formal gripes represent only a small portion of the problems and frustrations patients may encounter with their care.

To those in health care, it can seem as though every patient is a volcano waiting to explode at the slightest provocation. When I did a Google search of “unhappy patients,” I found hundreds of articles, many of them written by doctors for other doctors and often conveying the message that, gosh, patients these days are so demanding and unrealistic that no one can ever hope to keep them happy.

To be sure, there are patients who are impossible to please. But this mindset overlooks an inconvenient truth: When patients complain, it’s often a reliable sign that a health care organization is falling short in some area. If patients are consistently unhappy with their surgery results, are they too demanding or has the surgeon been unclear about what the expectation should be? When patients complain that the office staff is rude, are they just being touchy or is there a genuine customer service problem? If a complaint goes unvoiced, should health care providers breathe a sigh of relief or should they see it as a lost chance to build trust with the patient and provide better care?

There’s been an interesting shift in the past decade or so – away from viewing patient satisfaction as nice but optional and toward seeing it one of the essential ingredients in quality health care.

Nowadays we can find people like Mary Pat Whaley, a medical practice management consultant, proclaiming she “can’t wait to hear patient complaints.” Why? Because, Whaley explains, “complaints are the only opportunity managers have to understand the patient’s experience and hear in their own words what went wrong for them.”

Her blog posting on the topic last fall sparked similar sentiments from other medical practice managers. “Clinics should LOVE feedback,” one person wrote. “Otherwise you’re completely at a loss for what the practice’s weak spots are (and every practice has one or more).”

Someone who used to be “terrified” of patient complaints wrote that she now sees them for what they are: “an incredible opportunity to see things through the patient’s eyes and make improvements.”

Whether these positive attitudes are being conveyed to patients isn’t clear, though. Even allowing for cultural differences, the Swedish study suggests that many patients simply don’t, or won’t, complain. The authors uncovered several reasons: People didn’t have the energy, didn’t think it would make a difference, or didn’t know whom to approach with a complaint. In some cases, patients didn’t complain because they were afraid of reprisals. The study also found that when patients had grounds for complaining, those who reported positive health care experiences in the past were more likely to file a complaint than those whose experiences were negative – possibly because they were more confident there would be a response.

Not surprisingly, bad experiences led to less overall trust, setting the stage for poor relationships between patients and clinicians and making patients less likely to agree with or follow recommendations for their care.

Baird eventually did receive a call from a hospital department manager who apologized for the mix-up and told her when to arrive for her surgery. The nurse who admitted her knew there had been a problem and apologized too. The surgery, Baird wrote, “went well and the staff was thorough and confident.”

But trust is fragile and easily broken, she wrote. “… It reminded me that a patient experience is only as strong as the weakest link. Everything about the experience must be safeguarded in order to earn patient trust.”

Standing up for the introverts

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Are introverts misunderstood and oppressed?

According to a new book, “Quiet: The Power of Introverts in a World That Can’t Stop Talking,” American culture is so centered on extroversion that we’re at real risk of overlooking the value of the introverts among us.

I’d stand up and cheer, but I’m introverted and, well, it’s just not something I do.

I came across Susan Cain’s new book via Second Opinion, the MinnPost health blog by Susan Perry, who also linked to a recent interview with Cain that appeared in Scientific American.

The interview is quite fascinating to read. In it, Cain makes this observation about what she describes as a bias in American culture in favor of extroversion:

In our society, the ideal self is bold, gregarious, and comfortable in the spotlight. We like to think that we value individuality, but mostly we admire the type of individual who’s comfortable “putting himself out there.” Our schools, workplaces and religious institutions are designed for extroverts. Introverts are to extroverts what American women were to men in the 1950s – second-class citizens with gigantic amounts of untapped talent.

And this, on how to tell the difference between someone who’s introverted and someone who’s extroverted:

Introverts prefer quiet, minimally stimulating environments, while extroverts need higher levels of stimulation to feel their best. Stimulation comes in all forms – social stimulation, but also lights, noise, and so on. Introverts even salivate more than extroverts do if you place a drop of lemon juice on their tongues! So an introvert is more likely to enjoy a quiet glass of wine with a close friend than a loud, raucous party full of strangers.

It’s also important to understand that introversion is different from shyness. Shyness is the fear of negative judgment, while introversion is simply the preference for less stimulation. Shyness is inherently uncomfortable; introversion is not. The traits do overlap, though psychologists debate to what degree.

It’s not clear how much of this is pop psychology and how much is grounded in genuine biology. The terms “extrovert” and “introvert” were first popularized by Carl Jung, the founder of analytical psychology, who used them to describe how individuals direct their psychic energy – inward or outward.

Although the concepts are now widely recognized, they remain somewhat squishy. If there’s a consensus about them, it’s that most people have varying degrees of introversion and extroversion in their personalities. Cain cites research suggesting that about one-third to one-half of the population could be considered introverted.

So is there truly a bias against introversion? Perhaps so, perhaps not. Culture does seem to play at least some role in how we perceive personality traits that are most desirable. Among those whom Cain interviewed for her book were Asian-American students who felt “alienated from the brash, back-slapping atmosphere of American schools.” Others who study this issue note that in some cultures – Finland, for instance, or India – introversion is valued more than it is in the United States.

I found some interesting perspective on the Overcoming Bias blog, where it’s suggested that many do-it-yourself personality tests and quizzes do indeed seem to favor extroversion. In some of these quizzes, introversion “is a ‘warning sign’ that you might not be as happy as you could be,” a commenter observed.

Perhaps extroverts and introverts just don’t really understand each other very well, suggests Mary Carpenter in a 2007 column that appeared in the Washington Post. She writes: “Jung cautioned that people tend to value their own psychological type the most. Extroverts in particular have trouble acknowledging the opposite tendencies. ‘You can’t be an introvert,’ one of my most extroverted colleagues insists. ‘You have so many friends.’”

So are we headed for what Forbes magazine this week called “the quiet revolution of the 50 percent”? Cain’s book delves into some new research on introversion in leadership, innovation and creativity, and she has said in interviews that the U.S. may be on the verge of a new understanding of introversion.

What do readers think? Is it time for the introverts to stand up and be counted?

A vision of future health care

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I have seen a vision of the future of health care and it looks like… well, I don’t know exactly what, because it hasn’t happened yet. But it’s intriguing for sure.

Local health providers were offered an opportunity last week to redesign the health care delivery system in ways that help lower costs, enhance quality and result in better outcomes for patients.

Concepts such as “accountable care community,” “episodes of care” and “patient-centered medical home” were a big part of the discussion. But I’m going to skip, for now, an exploration of what these mean and focus on a different issue.

The individuals at last week’s meeting – physicians, medical directors, clinic administrators, hospital executives, hospital board members – were given a glimpse of the view at 30,000 feet. What I want to know, and what I suspect many others want to know, is what the view looks like in a real, boots-on-the-ground kind of way. In other words, how it will affect the patient experience – because all too often, as policymakers start tinkering with the system, this is an element that’s overlooked or misunderstood.

There’s a lot to recommend the new care delivery models that are being talked about and implemented at various sites around the U.S. These models are moving away from the current fragmented, respond-to-the-patient’s-most-immediate-problem approach and moving toward more coordination, prevention and effective chronic disease management.

It would be hard to argue with these goals, yet in the real world something can be lost between theory and practice.

Take the patient-centered medical home. Part of this concept involves team care – physicians, nurse practitioners and other clinicians applying their unique skills on behalf of overall patient care. Sounds like a good idea, yes? But early results from medical practices that have implemented the medical home model found that at many of the pilot sites, patient satisfaction actually went down.

This doesn’t necessarily mean the model itself is fatally flawed or that patient satisfaction won’t improve once the transition phase is past. It suggests, however, that patients themselves aren’t sure they like the experience of belonging to a medical home. Some of it may be confusion or a lack of information on what the concept means. Some of it may be frustration with seeing clinicians other than the doctor at their appointments.

These early patient satisfaction findings could be shrugged off as unimportant or as evidence that patients are resistant to change or incapable of understanding the medical home model.

But they could also be looked at another way. If patients don’t understand why their clinic is turning into a “medical home,” what has been done to educate and prepare them for this change – and whose responsibility is this? If patients are uneasy at seeing multiple clinicians, perhaps it’s because they’re concerned – and rightly so – over the loss of continuity and the potential for lapses in communication, not to mention the disruption of one of the relationships that, for many patients, matters the most – the relationship with the doctor.

I’m not in a position to suggest to local health care providers what they ought to do. No doubt there’ll be many serious strategic discussions in the weeks and months ahead as they hash out their options.

On behalf of patients, though, I’m making a plea: At some point, preferably before final decisions are made, there should be community input – and not just from local movers and shakers but from a cross-section of patients with an honest, real-life perspective on what they want and what they value.

Among the important questions asked at the meeting last week was this: How do you motivate patients to do the right thing? Inevitably, patients are part of this and their buy-in will be critical.

However it shakes out, there’s an opportunity here to do something. Is it going to be done for patients or is it going to be done to them? Better yet, how about doing it with them? Now that would be transformational.

Image: “The Crystal Ball,” John William Waterhouse, 1902

Risk and the middle-aged heart

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If you avoid smoking and have your blood pressure and cholesterol under good control when you’re in your 40s, it’s likely to pay off with less chance of heart disease by the time you’re 80. Ignore your cardiovascular risk factors in middle age and it could come back to haunt you later.

This seems to be one of the take-home messages in a study newly published in the New England Journal of Medicine that examines the lifetime risk of cardiovascular disease.

The researchers analyzed data from the Cardiovascular Lifetime Risk Pooling Project, a collection of 18 studies involving more than 250,000 American adults that measured their cardiovascular risk factors at age 45, 55, 65 and 75 years old.

The chief finding: The more risk factors – high cholesterol, uncontrolled high blood pressure, tobacco use, diabetes – people had in their 40s and 50s, the greater their risk of dying by age 80 of a heart attack or stroke. Those with the fewest risk factors in middle age “had substantially lower risks of death from cardiovascular disease through the age of 80 years than participants with two or more major risk factors,” the authors of the study wrote.

The difference was 4.7 percent vs. 29.6 for men and 6.4 percent vs. 20.5 percent for women.

In other words, the seeds of cardiovascular disease tend to be sown earlier in life than many Americans are accustomed to thinking.

The study is a marked departure from most previous studies, which usually have focused on short-term heart disease risk rather than overall lifetime risk.

It carries some big implications for how we ought to approach risk reduction in the context of cardiovascular disease. Individuals in their 40s might not view a heart attack as something they need to immediately worry about when their lifetime risk could in fact be quite high, Dr. Jarett Berry, one of the lead authors of the study, explained in an accompanying news release.

“If we want to reduce cardiovascular disease, we need to prevent the development of risk factors in the first place,” he said. “What determines your heart disease risk when you are 70 or 80 is what your risk factors are when you’re 40.”

This might sound like a “Duh!” conclusion. Fewer risk factors mean… well, lower risk, right?

The NEJM study in fact reinforces a couple of points: First, that the well-known risk factors we all talk about when it comes to heart disease – smoking, high cholesterol and so on – really do matter; second, that cardiovascular risk factors often are stealthily at work behind the scenes by early middle age. Maybe we should be thinking “the sooner the better” on reducing heart attack risk, rather than “better late than never.”

Generation X meets the flu

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How do you get a generation of healthy young adults to start paying attention to infectious diseases like influenza?

Perhaps they’re paying a little more attention than we realize. Researchers at the University of Michigan recently released a report on how American 30-somethings responded to the H1N1 flu pandemic of 2009-10 and concluded they “did reasonably well in their first encounter with a major epidemic.”

The report is based on survey data collected during the H1N1 outbreak from about 3,000 individuals aged 36-39. More than half of the respondents – 65 percent, to be exact – said they were at least moderately concerned, and nearly 60 percent said they were tracking the news about the novel flu virus either very closely or moderately closely.

Their interest didn’t necessarily translate into action. Only about one in five said they actually received the H1N1 flu vaccination. But the majority of the survey participants described themselves as being fairly well informed about the flu epidemic, with the highest level of interest reported by parents of young children.

Those surveyed also seemed pretty good at discerning reliable sources of information. They put physicians, the National Institutes of Health, their local pharmacist and county health nurses at the top of the credibility list. At the bottom of the heap? YouTube videos, drug company commercials and Wikipedia.

The survey findings are frankly more positive than I would have expected. In my younger adult days, I wasn’t particularly concerned about influenza and didn’t believe flu shots were necessary for people in my age group (although, to be fair, annual immunizations against influenza weren’t recommended back then for the under-65 crowd). I feel differently these days, perhaps because I’m older and because there’s more – and better – information available.

When it comes to infectious disease, why would the attitudes of young adults matter? There seems to be an increasing urgency among public health experts to address this demographic, and not only where influenza is involved.

Most older adults have some memory of disease outbreaks such as measles or whooping cough, writes Dr. David Detert in a recent entry at the Discover ACMC blog. “What we are faced with today is that a majority of our population hasn’t experienced those types of dire situations or has forgotten what it was like years ago before immunizations.”

As a result, many younger adults might underestimate the risk or severity of infectious diseases and may choose not to vaccinate because they perceive the benefit is so slight, he writes. And when that happens, herd immunity can diminish and set the stage for a resurgence of disease in a population that’s not well protected.

“You might hear people say, ‘It’s OK, we just don’t have outbreaks like that anymore,’” Dr. Detert writes. “What you have to remember is that our frame of reference now is during a time where we have had the benefit of being an immunized population; compare that to years ago, before vaccines were developed, and it’s a different story.”

It’s not always an easy message to sell. Young adults these days are bombarded with multiple messages, often conflicting and sometimes from sources that are biased or unreliable.

The University of Michigan study suggests, however, that younger adults do take an interest in health and disease and would likely be receptive to good information.

The H1N1 flu epidemic, which turned out to be relatively mild in the United States, wasn’t the first widespread disease outbreak and won’t be the last, points out Jon D. Miller, author of the Generation X Report, in an accompanying news release. “In the decades ahead, the young adults in Generation X will encounter numerous other crises – some biomedical, some environmental, and others yet to be imagined. They will have to acquire, organize and make sense of emerging scientific and technical information, and the experience of coping with the swine flu epidemic suggests how they will meet that challenge.”

Photo: Train commuters in Mexico City wear masks during the H1N1 influenza outbreak of 2009-10. Source: Wikimedia Commons

The aspirin quandary

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An aspirin a day is supposed to keep heart attacks away… or does it?

A growing body of research is casting doubt on the longstanding belief that daily low-dose aspirin can help prevent heart problems in people who are otherwise healthy. The latest evidence comes from a study published earlier this month in the Archives of Internal Medicine, which analyzed nine studies involving more than 102,000 American adults and concluded that for many people, daily aspirin is unlikely to be beneficial and might even be harmful.

Talk about putting the common wisdom in a whole new light.

This particular issue resonates with me in a very personal way. I have high blood pressure, which is a known cardiovascular risk, and I’m currently in a quandary over aspirin use. Should I take it daily or not? Would it help or would it hurt? My doctor has suggested it (although he hasn’t pushed it and he’s been up front about the lack of a clearly established benefit for primary prevention of a cardiovascular event) but I’m struggling to decide.

For me, the study in the Archives of Internal Medicine arrived at an opportune time. Among the take-home points I gleaned: The rate of fatal heart attacks and strokes was essentially the same among people who took daily low-dose aspirin as those who didn’t. Those who took aspirin each day did have a 10 percent lower risk of heart disease but this was fueled mainly by a reduction in fatal heart attacks. There were no differences between men and women.

Of note, those who took daily aspirin had a 70 percent higher chance overall of problems with bleeding due to aspirin’s tendency to thin the blood. The risk of serious bleeding was 30 percent higher for the aspirin-takers than for those who didn’t take daily aspirin.

Another way of viewing the odds: For every two cases of heart disease or stroke prevented by daily aspirin use, there were more than three cases of serious bleeding. Overall, about 162 healthy adults would have to take aspirin each day for six years in order to avoid just one non-fatal heart attack, the researchers wrote.

Given these statistics, is it time for the health community to stop making a blanket recommendation for every American adult – even those at only moderate risk of heart disease – to take daily aspirin?

I think we’re beginning to see a shift in how prevention and medical intervention are discussed. At one time the emphasis was on taking action, even if the risks and/or benefits weren’t entirely clear. If there was a chance that aspirin or antibiotics or a CT scan it would help, it was worth it – or so the thinking went.

In recent years a new element has crept into the conversation. There seems to be a greater willingness, by clinicians as well as the public, to question whether a given intervention will truly help the patient. There’s more awareness that medical action also entails some risk, and that the risk may be higher for some people than for others.

Unfortunately, it also has brought more nuance and more confusion into the decision-making process. If daily aspirin use is beneficial to a subset of people, who are they and does this group include me? How do I weigh the risk vs. the benefit in the context of my own health and cardiovascular risk factors?

I’ve gone so far as to buy a bottle of low-dose aspirin. It’s sitting in the medicine cabinet but remains unopened. I’m still mulling over all the studies and just can’t make up my mind.

Image: Clipart.com

A letter to Paula Deen

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Paula, Paula, Paula.

By now, you’re probably tired of all the fuss – the criticism of your calorie- and cholesterol-drenched cuisine, your recent revelation that you have type 2 diabetes, your new contract with Novo Nordisk to pitch one of their diabetes drugs.

I’m not going to nag or get all judgmental on you. Others have already done so – for instance, chef and Food Channel host Anthony Bourdain who sarcastically tweeted this week, “Thinking of getting into the leg-breaking business, so I can profitably sell crutches later.” Or an editorial in the Star Tribune of Minneapolis, which criticized you for promoting “a lifestyle elevating feeling good for a moment above everything else” and concluded, “It’s time for her to become a force for good instead of a force for fat.”

But I have to ask, Paula: What the heck were you thinking?

I’m a teensy bit embarrassed to admit that although I recognize your name and know you’re a celebrity chef/restaurateur who has written books and appeared on TV, I didn’t know much about your culinary style other than that it’s “Southern.” After the story broke this week, I looked up some of your recipes online and I was… well, taken aback, to say the least.

Deep-fried apple turnovers. Macaroni and cheese loaded with butter, sour cream, milk and cheddar cheese. A pie made with Twinkies. A “chocolate cheese fudge” containing half a pound of Velveeta, half a pound of butter and two pounds of confectioner’s sugar. Velveeta doesn’t belong in fudge, Paula. It isn’t even a food.

In some ways, though, I can’t help admiring you. From the start of your career, you aimed unerringly at America’s pudgy underbelly – our collective instinct toward food laden with sugar, butter and grease. It was a smart business decision. You made millions catering to the most unbridled aspects of the human appetite and America was only too happy to help. In this, your fans have been complicit.

But is this what you really want to be remembered for? Your love of food appears to be genuine but is this the example you wanted to set? Now the deep-fried chickens have come home to roost in the form of type 2 diabetes and what I see is… denial. Sorry to be harsh, Paula, but it’s true. You even kept your diagnosis quiet for three years, meanwhile continuing to serve up butter, sugar and calories like there was no tomorrow.

Lending your name and celebrity reputation to help a pharmaceutical company hawk its diabetes drug doesn’t even the score. At best, your fans are probably wondering if you’re being used. At worst, your critics are accusing you of being an opportunist.

The whole lifestyle change thing is hard. I get that. What I don’t get is how someone with your brains, your talent, your business acumen, your charm, ever ended up here in the first place. It didn’t have to come to this, Paula, and it’s not too late to make amends. Put down the butter and walk away. I’m surviving just fine without Twinkie pie and fried cheesecake, and so can you.

Photo: Associated Press

Clutter in the clinic

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Can a doctor have a cluttered office or waiting room and still be perceived as clinically competent?

Perhaps so, but too much clutter – stacks of outdated magazines in the waiting room, charts piled on a desk, medical equipment parked in the hall, kiddie play area in chaos – can send the wrong message and make patients start to wonder: If the doctor and staff can’t keep their workplace clean, what else can’t they manage?

American Medical News tackled the clutter challenge this week in an article that minces few words about why it matters.

Here’s the assessment of Kristin Baird, CEO of the Baird Group, which consults with hospitals and medical practices on how to improve the patient experience:

Even though a place might be clean and there are no infection-control issues, if the patient sees a bunch of clutter, they will think the place is not clean. They will think, ‘Do I have to worry about catching something here?’ They start to not trust you.

It can also look unprofessional, the article points out. Take the pictures, trinkets and other items people often bring to personalize their desk. Staff may think it helps make the clinic look more homelike but too much of it “doesn’t make patients feel at home most of the time,” Johnny Hagerman, assistant vice president of marketing for MedStar Health, told American Medical News. “It makes them feel the place is disorganized and not well managed.”

Patients clearly do notice these things. A review on Yelp for a San Francisco physician, for instance, gave the doctor one out of five stars and offered a heaping helping of criticism, including this observation about the waiting room: “hairs on the floor and it’s kind of dusty.” The reviewer concluded that one visit to this doctor “was enough for me.”

Another online reviewer on the East Coast dinged a doctor for a cluttered, outdated office (“She should clean up her office. First impressions are important.”) and actually bailed out without waiting for an exam.

As dental practice consultant Ken Smith puts it, “The patient likely will not tell their friends about the great margin on that crown, but they will be sure to mention the dirty operatory lamp or messy waiting area.”

One of my personal beefs: cluttered signage. (Click here for a great example.) What’s with all the confusing arrows? Which sign am I supposed to read first?

Neatness is important enough that many of the standardized patient surveys for both hospitals and medical practices ask the question: Was the waiting room/exam room/hospital room neat and clean?

There often seems to be a gap between medical professionals and patients on this issue. Doctors want to be judged on the basis of their skills, knowledge and caring, not on something as superficial-seeming as the state of their waiting room. But how is the average person supposed to gauge these qualities? Often it comes down to what the patient can see and evaluate firsthand, and this includes clutter – unremarked-on when it’s not there but conspicuous when it is.

Photo: West Central Tribune

Swapping germs with the dog

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Here’s yet another reason to wash your hands after playing with the dog: Researchers in Europe have uncovered a new piece of evidence suggesting noroviruses, the group of bugs often responsible for what’s known as “stomach flu,”  can be transmitted from pet dogs to humans.

This tidbit of information appears in the current issue of the Journal of Clinical Virology (thanks to barfblog, a food safety blog published by Doug Powell of Kansas State University, for the heads up) and it’s worth a glance by anyone who lives with a dog or has frequent contact with dogs.

Noroviruses, as many folks already know, are among the most common causes of gastroenteritis, which is characterized by acute vomiting, diarrhea and stomach cramps. The virus is typically spread through contaminated food or drink, direct contact with someone who’s sick, or hand-to-mouth contact with a surface – a countertop, for instance – that’s contaminated with the virus.

Apparently we might need to include canine companions in this equation. A group of Finnish researchers analyzed 92 fecal samples from indoor pet dogs, using illness in the household as their criterion – either one of the humans or dogs in the home had to have vomiting or diarrhea in order to be considered for the study.

The analysis revealed the presence of human norovirus in four of the dogs who’d had direct contact with a human showing symptoms of the virus. The researchers also found that three of the four samples contained a norovirus with the same genotype, GII, that is one of the most common strains to infect humans.

The researchers wrote, “Our results suggest that HuNoVs can survive in the canine gastrointestinal tract. Whether these viruses can replicate in dogs remains unresolved, but an association of pet dogs playing a role in transmission of NoVs that infect humans is obvious.”

Studies on norovirus strains among dogs have been few and far between. A Portuguese team analyzed stool samples from 105 dogs at shelters, veterinary clinics and pet stores and reported in a paper, published in 2010 in the Emerging Infectious Diseases journal, that 40 percent of the samples that came from dogs with diarrhea tested positive for a novel form of norovirus.

Another study, this one conducted in Italy, put the overall prevalence of norovirus among dogs at around 2 percent and noted that it may be possible, under certain circumstances, for the virus to be transmitted to people.

More research obviously needs to take place before a definitive link can be established. The ability of dogs and humans to swap pathogens is not surprising, however. About a year ago, another study found several documented cases of human infectious diseases ranging from hantavirus to plague that reportedly were transmitted by household dogs and cats who slept with their human companions.

Most of us with companion animals are devoted to our pets and aren’t about to give them up. The risk of animal-to-human, or zoonotic, disease just comes with the territory. If anything, however, the emerging knowledge about norovirus in dogs underscores that disease transmission is a clear possibility and that hand-washing, sanitation and attention to overall pet health can be a dog owner’s best friend.

Photo: Wikimedia Commons

The noisy hospital

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Everyone knows that hospitals aren’t the best place to go for a good night’s sleep.

A study published this week in the Archives of Internal Medicine adds more proof with several new findings, including one that’s truly startling: The average noise level in patient rooms can reach 80 decibels – almost as loud as a chainsaw.

How about a little more peace and quiet, please?

Researchers at the University of Chicago Medical Center studied about 100 adult patients, tracking how well they slept in the hospital and how much noise they were exposed to.

Among the findings:

- Although hospital rooms were less noisy at night than during the day, they were far from quiet.

- The average nighttime noise level in inpatient rooms was around 50 decibels, which exceeds recommendations by the World Health Organization; 30 to 40 decibels is considered the maximum for a hospital setting.

- At times, noise levels spiked to 80 decibels. This is the equivalent of a chainsaw or the typical home stereo listening level. It’s louder than the noise of an average factory or office, a busy street or a small orchestra, and only a couple of notches below the noise level of heavy truck traffic.

- The noise came from many sources: staff conversations, roommates, alarms. The loudest source? Intercoms and pagers.

- The noisier the room, the less likely it was that the patient slept well. On average, patients exposed to the highest nighttime noise levels slept 76 minutes less than those exposed to the least amount of noise. Sleep quality for patients in the noisiest rooms also tended to be worse.

Dr. Vineet Arora, who led the study, told Reuters Health, “One of the most common complaints that patients will report is that they had a difficult night sleeping.” The risk is that it could hinder the patient’s recovery, she explained.

Sleep experts who reviewed the study say there could be additional factors to blame for sleep disruption in the hospital. Patients simply might not sleep as well when they’re sick, they suggested. Also, patients who are sicker often have more nurses coming in and out of the room to monitor them during the night, administer medications and so on.

There doesn’t seem to be a cheap or easy fix to the hospital noise problem. Long-lasting solutions often involve engineering, such as installing wall and floor coverings that absorb sound or ditching overhead intercoms in favor of wireless pagers.

Although I don’t advocate tearing down older hospitals and starting over, new construction does offer opportunities to incorporate better noise reduction strategies. When Rice Memorial Hospital here in Willmar built a new patient wing a few years ago, considerable attention was paid to creating an environment that would be healing for both patients and staff. For starters, all the patient rooms are now private. The layout is designed so that no patient room is directly opposite a nurse’s station or utility closet or other potentially noisy location. Corridors for staff use, carts, equipment and so on are separate from patient corridors. Overhead paging also was replaced with wireless communication. When I’ve visited friends and relatives hospitalized at Rice, one of the first things I usually notice is how quiet it is.

Unfortunately, many hospitalized patients will have to continue to put up with a certain amount of noise. For them, sleep experts have these suggestions: Ask staff to keep the room door closed. Wear noise-canceling headphones. Open the window blinds during the daytime to let in natural light and try to walk around the day if they’re physically able. Patients might not be able to change the environment but small changes can help make hospital noise levels less bothersome.

Photo: U.S. National Archives and Records Administration