美国国家公共电台 NPR Should Hospitals Be Punished For Post-Surgical Patients' Opioid Addiction?

 

LINDA WERTHEIMER, HOST:

There's an emerging movement to hold hospitals accountable for people addicted¹ to prescription² opioids resulting from a hospital stay.

From member station WBUR in Boston, Martha Bebinger reports.

MARTHA BEBINGER, BYLINE³: Katie Herzog's withdrawal⁴ symptoms began about a month after back surgery. The 68-year-old consulting firm CEO had the surgery in April at a prominent Boston hospital.

KATIE HERZOG: I had sort of almost, like, bone spurs growing into my spine⁵. And there was no room left in the spinal⁶ canal for spinal fluid at all.

BEBINGER: The surgery lasted nine hours. Hertzog left the hospital with a prescription for Dilaudid, an opioid used to treat severe pain and instructions to take two every four hours as needed. She took the full dose for about two weeks, then began worrying about addiction⁷.

HERZOG: I said, how do I taper⁸ off this? I don't want to stay on this drug forever. You know, what do I do? And I never got any clear answer. The visiting nurse would say well, whatever your doctor says. The internist says, what does the surgeon say? You know, the surgeon doesn't do medicine. It was his resident or somebody else in his group who did it.

BEBINGER: When none of these people explained how to go off the Dilaudid, Hertzog found a Canadian guide to tapering⁹ opioids. Hertzog tracked her progress milligram by milligram in a pocket diary.

HERZOG: So I started tapering from 28, 24, 16. I can show you, you know, all the way that I went down.

BEBINGER: Her one month post-surgery appointment coincided with Herzog's first day off Dilaudid. By the time she got to the doctor's office, Hertzog was sick.

HERZOG: I was teary. I had diarrhea. I was vomiting¹⁰ a lot. I had muscle pains, headache. I had a low-grade fever. The surgeon said, I think you have a virus. You should go see your internist. And the P.A. was there, and she thought so too.

BEBINGER: So Hertzog went home thinking she had the flu and suffered through five days of what she came to realize was withdrawal.

HERZOG: I had every single symptom in the book, and there was no recognition by these really professional, senior, seasoned doctors that I was going through withdrawal.

BEBINGER: Herzog isn't naming any of her five or more doctors and nurses at two hospitals because she sees her case as a system-wide problem.

Dr. Andrew Kolodny, director of Physicians for Responsible Opioid Prescribing, says many physicians don't recognize withdrawal because they do not realize how quickly a patient can become dependent on pain meds.

ANDREW KOLODNY: A patient who takes an opioid a few times a day for as little as one week is going to begin to develop physiological¹¹ dependence¹² on the drug, which means that they're likely to feel symptoms when they try and come off.

BEBINGER: Sometimes that dependence triggers full-blown addiction. Now, a handful of doctors and hospital administrators¹³ are asking, if an opioid addiction starts with a prescription after surgery or some other hospital-based care, should the hospital be penalized¹⁴ as they are for infections and readmissions? Is addiction a medical error?

Kolodny likes the idea.

KOLODNY: It might help promote more cautious prescribing. It might help change practice.

BEBINGER: But penalizing¹⁵ hospitals for addiction may conflict with payments tied to patient satisfaction surveys that ask, did your hospital address your pain? Dr. Gabriel Brat¹⁶ is a trauma¹⁷ surgeon with the Harvard Medical School.

GABRIEL BRAT: This is a real concern that patients who may feel that their pain is undermanaged may take that out as it were in these patient report cards.

BEBINGER: Which may be one reason three of four post-surgery patients had leftover¹⁸ opioid pills according to a recent study. Dr. Brat says only about 10 percent of patients need lots of pain meds, but doctors can't tell who they are.

BRAT: Many surgeons are still prescribing opioids for the subset of patients that have higher requirements as opposed to, for the majority of the patients who often aren't taking a very small percentage of the pills that they're prescribed.

BEBINGER: As Hertzog discovered, there are no set guidelines for which opioids to prescribe after surgery at what dose and for how long. And there are no protocols¹⁹ for helping²⁰ patients ease off pain meds and cope with withdrawal.

For NPR News, I'm Martha Bebinger in Boston.

WERTHEIMER: This story is part of a reporting partnership²¹ with NPR, WBUR and Kaiser Health News.

(SOUNDBITE OF PABLIE'S "SINCE THEN")

1 addicted   

adj.沉溺于....的，对...上瘾的

参考例句：

• He was addicted to heroin at the age of 17.他17岁的时候对海洛因上了瘾。
• She's become addicted to love stories.她迷上了爱情小说。

2 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

3 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

4 withdrawal   

n.取回，提款；撤退，撤军；收回，撤销

参考例句：

• The police were forced to make a tactical withdrawal.警方被迫进行战术撤退。
• They insisted upon a withdrawal of the statement and a public apology.他们坚持要收回那些话并公开道歉。

5 spine   

n.脊柱，脊椎；(动植物的)刺；书脊

参考例句：

• He broke his spine in a fall from a horse.他从马上跌下摔断了脊梁骨。
• His spine developed a slight curve.他的脊柱有点弯曲。

6 spinal   

adj.针的，尖刺的，尖刺状突起的；adj.脊骨的，脊髓的

参考例句：

• After three days in Japan,the spinal column becomes extraordinarily flexible.在日本三天，就已经使脊椎骨变得富有弹性了。
• Your spinal column is made up of 24 movable vertebrae.你的脊柱由24个活动的脊椎骨构成。

7 addiction   

n.上瘾入迷，嗜好

参考例句：

• He stole money from his parents to feed his addiction.他从父母那儿偷钱以满足自己的嗜好。
• Areas of drug dealing are hellholes of addiction,poverty and murder.贩卖毒品的地区往往是吸毒上瘾、贫困和发生谋杀的地方。

8 taper   

n.小蜡烛，尖细，渐弱；adj.尖细的；v.逐渐变小

参考例句：

• You'd better taper off the amount of time given to rest.你最好逐渐地减少休息时间。
• Pulmonary arteries taper towards periphery.肺动脉向周围逐渐变细。

9 tapering   

adj.尖端细的

参考例句：

• Interest in the scandal seems to be tapering off. 人们对那件丑闻的兴趣似乎越来越小了。
• Nonproductive expenditures keep tapering down. 非生产性开支一直在下降。

10 vomiting   

吐

参考例句：

• Symptoms include diarrhoea and vomiting. 症状有腹泻和呕吐。
• Especially when I feel seasick, I can't stand watching someone else vomiting." 尤其晕船的时候，看不得人家呕。”

11 physiological   

adj.生理学的，生理学上的

参考例句：

• He bought a physiological book.他买了一本生理学方面的书。
• Every individual has a physiological requirement for each nutrient.每个人对每种营养成分都有一种生理上的需要。

12 dependence   

n.依靠，依赖；信任，信赖；隶属

参考例句：

• Doctors keep trying to break her dependence of the drug.医生们尽力使她戒除毒瘾。
• He was freed from financial dependence on his parents.他在经济上摆脱了对父母的依赖。

13 administrators   

n.管理者( administrator的名词复数 )；有管理（或行政）才能的人；（由遗嘱检验法庭指定的）遗产管理人；奉派暂管主教教区的牧师

参考例句：

• He had administrators under him but took the crucial decisions himself. 他手下有管理人员，但重要的决策仍由他自己来做。 来自辞典例句
• Administrators have their own methods of social intercourse. 办行政的人有他们的社交方式。 来自汉英文学 - 围城

14 penalized   

对…予以惩罚( penalize的过去式和过去分词 )； 使处于不利地位

参考例句：

• You will be penalized for poor spelling. 你拼写不好将会受到处罚。
• Team members will be penalized for lateness. 队员迟到要受处罚。

15 penalizing   

对…予以惩罚( penalize的现在分词 )； 使处于不利地位

参考例句：

• This is more than just penalizing a company that you are mad at. 她说：这将远远超过惩罚一个你感到不满的公司。

16 brat   

n.孩子；顽童

参考例句：

• He's a spoilt brat.他是一个被宠坏了的调皮孩子。
• The brat sicked his dog on the passer-by.那个顽童纵狗去咬过路人。

17 trauma   

n.外伤，精神创伤

参考例句：

• Counselling is helping him work through this trauma.心理辅导正帮助他面对痛苦。
• The phobia may have its root in a childhood trauma.恐惧症可能源于童年时期的创伤。

18 leftover   

n.剩货，残留物，剩饭；adj.残余的

参考例句：

• These narrow roads are a leftover from the days of horse-drawn carriages.这些小道是从马车时代沿用下来的。
• Wonder if that bakery lets us take leftover home.不知道那家糕饼店会不会让我们把卖剩的带回家。

19 protocols   

n.礼仪( protocol的名词复数 )；（外交条约的）草案；（数据传递的）协议；科学实验报告（或计划）

参考例句：

• There are also protocols on the testing of nuclear weapons. 也有关于核武器试验的协议。 来自辞典例句
• Hardware components and software design of network transport protocols are separately introduced. 介绍系统硬件组成及网络传输协议的软件设计。 来自互联网

20 helping   

n.食物的一份&adj.帮助人的，辅助的

参考例句：

• The poor children regularly pony up for a second helping of my hamburger. 那些可怜的孩子们总是要求我把我的汉堡包再给他们一份。
• By doing this, they may at times be helping to restore competition. 这样一来, 他在某些时候,有助于竞争的加强。

21 partnership   

n.合作关系，伙伴关系

参考例句：

• The company has gone into partnership with Swiss Bank Corporation.这家公司已经和瑞士银行公司建立合作关系。
• Martin has taken him into general partnership in his company.马丁已让他成为公司的普通合伙人。