CORRESPON DENCE
Caring: deficiencies of hospital staff To the editor: I have a few comments to make in the way of constructive criticism. I had not been a patient in a fourbed room of a teaching hospital until a few months ago. What greatly surprised me was that my medical history and that of my roommates was obtained in the presence of three other patients in the room and any cleaning or dietary staff who happened to wander in. There was no attempt by the medical students, the nurses, the interns or the staff physician who took the detailed histories to ask the questions in private. I have no doubt that many patients do not give their full history because of the presence of other people. I admit that in the past I have erred in the same manner but I did my best to obtain medical histories and perform examinations in private. I'm sure that no physician would take the history of a patient in a waiting room with three or more people listening in. No, he would always deal with this in his private consulting room. No doubt it would take time to arrange for private sessions in a hospital, but it is something we should strive very hard for. We have always known that medical records must be confidential. The newspapers continually remind us of this, yet I am sure that my experience Contributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double.spaced and, except for case reports, should be no longer than 1½ manuscript pages.
is general throughout the country and never a thought is given to it. Another bugbear in a hospital is the steel siderails on beds. They are pulled up and down in a very noisy fashion by nearly all of the staff. Often the steel parts squeal against one another because no oil or graphite has been applied. This squealing, especially at night, is ear-splitting and frightening. For 20 years I have been showing staff how to use the siderails quietly, even though it takes 3 seconds longer. Some persons are sympathetic but most couldn't care less. They have not yet been inpatients. A.S. BROWN, MD Box 1, RR 7 St. Mary's, Ont.
Are hair dyes associated with bladder cancer? To the editor: We would like to add some comments and data to those presented in the letter by Drs. Meera Jam and Robert W. Morgan, and Lynn Elinson (Can Med Assoc J 117: 1131, 1977). They presented a concise review of the evidence from the literature leading to the hypothesis that exposure to hair dye may cause bladder cancer, and then discussed their data, which did not support this hypothesis. We extended a study on the risk factors in bladder cancer and tried to contact by mail, and by telephone if necessary, all the women who had participated in a previous study.1 We were successful in obtaining 50 pairs matched for sex and 10-year age groups; 31.2% of the case group and 33.1 % of the control group could
not be contacted, mainly because they had moved. Since this study population consisted of elderly people, several had moved into nursing homes or institutions for the chronically ill, or had died. With regard to the risk factors examined previously - smoking, consumption of coffee and artificial sweeteners, occupational exposure to chemicals or radiation, and history of tuberculosis or isoniazid treatment - this subgroup of 50 matched pairs showed a similar but less pronounced association of some risk factors with bladder cancer. For example, equal numbers of smokers were found in the case group and the control group, but heavier smoking and more prolonged exposure to smoke were noted in the case group. The numbers of persons who reported having used hair dye were similar in the case group (18 of 50) and in the control group (19 of 50). The colour or type of hair dye was not significantly different in the two groups. Oddly, both frequent use (frequency being classified as once a month, once every 2 or 3 months, less often or never) and hairdressing as an occupation seemed to show a protective effect; in other words, the control group appeared to have the greatest exposure to hair dye. With a chi-square calculation the effect was found to be significant at P < 0.01 for frequent use and P = 0.055 for occupation. This seemingly protective effect of exposure to hair dye is difficult to explain and may be an artefact. One possibility is that the women most sensitive to carcinogens may have
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Caring: deficiencies of hospital staff To the editor: I have a few comments to make in the way of constructive criticism. I had not been a patient in a fourbed room of a teaching hospital until a few months ago. What greatly surprised me was that my medical history and that of my roommates was obtained in the presence of three other patients in the room and any cleaning or dietary staff who happened to wander in. There was no attempt by the medical students, the nurses, the interns or the staff physician who took the detailed histories to ask the questions in private. I have no doubt that many patients do not give their full history because of the presence of other people. I admit that in the past I have erred in the same manner but I did my best to obtain medical histories and perform examinations in private. I'm sure that no physician would take the history of a patient in a waiting room with three or more people listening in. No, he would always deal with this in his private consulting room. No doubt it would take time to arrange for private sessions in a hospital, but it is something we should strive very hard for. We have always known that medical records must be confidential. The newspapers continually remind us of this, yet I am sure that my experience Contributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double.spaced and, except for case reports, should be no longer than 1½ manuscript pages.
is general throughout the country and never a thought is given to it. Another bugbear in a hospital is the steel siderails on beds. They are pulled up and down in a very noisy fashion by nearly all of the staff. Often the steel parts squeal against one another because no oil or graphite has been applied. This squealing, especially at night, is ear-splitting and frightening. For 20 years I have been showing staff how to use the siderails quietly, even though it takes 3 seconds longer. Some persons are sympathetic but most couldn't care less. They have not yet been inpatients. A.S. BROWN, MD Box 1, RR 7 St. Mary's, Ont.
Are hair dyes associated with bladder cancer? To the editor: We would like to add some comments and data to those presented in the letter by Drs. Meera Jam and Robert W. Morgan, and Lynn Elinson (Can Med Assoc J 117: 1131, 1977). They presented a concise review of the evidence from the literature leading to the hypothesis that exposure to hair dye may cause bladder cancer, and then discussed their data, which did not support this hypothesis. We extended a study on the risk factors in bladder cancer and tried to contact by mail, and by telephone if necessary, all the women who had participated in a previous study.1 We were successful in obtaining 50 pairs matched for sex and 10-year age groups; 31.2% of the case group and 33.1 % of the control group could
not be contacted, mainly because they had moved. Since this study population consisted of elderly people, several had moved into nursing homes or institutions for the chronically ill, or had died. With regard to the risk factors examined previously - smoking, consumption of coffee and artificial sweeteners, occupational exposure to chemicals or radiation, and history of tuberculosis or isoniazid treatment - this subgroup of 50 matched pairs showed a similar but less pronounced association of some risk factors with bladder cancer. For example, equal numbers of smokers were found in the case group and the control group, but heavier smoking and more prolonged exposure to smoke were noted in the case group. The numbers of persons who reported having used hair dye were similar in the case group (18 of 50) and in the control group (19 of 50). The colour or type of hair dye was not significantly different in the two groups. Oddly, both frequent use (frequency being classified as once a month, once every 2 or 3 months, less often or never) and hairdressing as an occupation seemed to show a protective effect; in other words, the control group appeared to have the greatest exposure to hair dye. With a chi-square calculation the effect was found to be significant at P < 0.01 for frequent use and P = 0.055 for occupation. This seemingly protective effect of exposure to hair dye is difficult to explain and may be an artefact. One possibility is that the women most sensitive to carcinogens may have
CMA JOURNAL/AUGUST 26, 1978/VOL. 119 307
