Your humble question: What are the current inhaled corticosteroids on the market, and what one would be best for me?
My humble answer: I'm glad you asked this question because I just answered it yesterday over at my asthma blog. Click here to get your answer.
Your humble question: Are there any new rescue medicine that have fewer side effects than Albuterol? I know it's a good asthma medicine, but sometimes it make my grandma very jittery.
My humble answer: The only other rescue medicine on the market is levalbuterol, which is marketed as Xopenex. Some studies show that it works better, lasts longer and has fewer side effects as albuterol, yet other studies show that this is nonsense. However, it's still something you might want to try. I'm not sure about the inhaler. But the 0.63 mg solution is supposed to be equivalent to 0.5cc (2.5mg) of albuterol sulfate.
Tuesday, January 31, 2012
Monday, January 30, 2012
Are asthmatics smarter than nonasthmatics?
The following is from healthcentral.com/asthma.
"Does asthma make you smarter?" (originally published on 6/13/11)
So does asthma really make you smarter? I'm not being facecious either by asking this. In fact, the idea that asthma makes you smarter is one of the aformentioned "Seven Benefits of Asthma."
Asthma certainly can make you smarter! Right?
I think so. I surmise asthma forces us to become philosphers of sorts, and philosophers must be perspicacious to see questions others haven't thought to ask such as, "Does Asthma Make You Smarter?"
I'm pondering this idea today because I had a patient recently who was admittedly a hardluck asthmatic. In fact, she's so hardluck she's become a good friend of mine.
She's admitted for asthma a lot, yet she's quite convivial, and she usually has to set down a book when I enter her room. It's often our love of stories that sparks a discussion, and usually we become so rapt in some intelligent idea -- often philosophical -- time gets lost, sometimes hours.
She and I also have the asthma link to discuss.
We both love to learn. Her bedside stand usually has a stack of books, and magazines, and newspapers. She might even have her laptop open to an interesting article, or her Kindle on.
Interestingly enough, one of our recent discussions was about my post about the benefits of having asthma, particularly about how I wrote that asthma can make you smarter.
She liked that idea, and noted asthma has obviously made both of us more astute. Perhaps near death experiences force one to appreciate and to think uniquely.
Seneca wrote about this 2,000 years ago, back when the most effective asthma medicine was patience. He wrote how having asthma forced him to find something useful to do with his mind, and he ultimately became a Senator and philosopher.
He wrote, "It is your body, not your mind as well, that is in the grip of ill health. Hence it may slow the feet of a runner and make the hands of a smith or cobbler less efficient, but if your mind is by habit of an active turn you may still give instruction and advice, listen and learn, inquire and remember, Besides, if you meet sickness in a sensible manner, do you really think you are achieving nothing?"
Now it's not scientifically proven that if you have asthma your brain will somehow magically become bigger and you will somehow develop a higher IQ. Yet it is a proven fact that if you read and think you WILL get smarter. It happens by default.
In fact, I read once that you have a memory muscle in your brain. Lack of thinking causes it to atrophy, yet excessive thinking causes this muscle to increase in scope and size, such as when an athlete pumps iron.
Another interesting fact about asthma is it forces you to take a time out. Often breathing exercises and relaxation exercises are needed to help you ease your mind and catch your breath.
New evidence, as you can see from this study, even shows that mindfulness meditation can help "relieve pain and improve memory by regulating a brain wave known as the alpha rhythm, which 'turns down the volume' on distractions."
While most asthmatics -- including myself -- may not be trained in mindless meditation, I think sometimes we're forced to do something similar to ease our minds and help us cope with our dyspnea.
Even if my perspicacity is on the wrong track and I'm spurious with the brain wave conception, many asthmatics do tend to read more. It beats sitting around feeling sorry for yourself when you're brothers are out in the allergy ridden woods chopping down trees.
Regarding this, Seneca wrote, "Leet me tell you, the things that provided me consolidation in those days, telling you to begin with that the thought which brought me this peace of mind had all the effects of medical treatment. Comforthing thoughts contribute to a person's cure; anything which raises his spirit benefits him physically as well. It was my Stoic studies that rally saved me. For the fact I was able to leave my bed and was restored to health I give the credit to philosophy."
Many asthmatics before and since have experienced a similar epiphany.
To delve into a good book is so much more productive, and fun, than to sit around and say, "Oh, woah is me!"
Sure you can ask, "Why me?" Yet those of us with good character take advantage or our down time and we make the best of it.
If you're like me and my good friend -- and Seneca, you'll find something fun to read, or an idea to mull over, or at least some productive hobby to keep you busy. And by default you'll make yourself smarter.
Thoughts?
Sunday, January 29, 2012
The most basic priority will help you become a better prophet
Every one of us has anxieties in our lives, things that we worry about. This might be especially true when we are hit by a recession, or the death of a friend or family, or are having trouble with a child. We might become so wrapped in our anxiety that we lose sight of the big picture. We might even blame God for our troubles, or wonder why He'd let such things happen.
Sometimes we become so wrapped up in our own anxieties that we leave God in search of answers somewhere else. We doubt that He exists. We feel as though he has abandoned us. Yet with a little soul searching, we usually find ourselves and, like the child who is away from his parents a long time, we yearn for their return.
Yet the Prophet Isaiah (Isaiah 49: 14-15), when the people of Israel felt anxiety and that God had abandoned them, explained, "Can a woman forget her own child, I will never forget you."
Likewise, when we feel anxiety, it's usually because we are worrying about things of which we have little control. We worry how we are to put food on the table, or the best clothing on our children. I presently worry that the mood changes that have effected my 7 year old after the death of her grandma and great grandma in the same day, might linger and effect the rest of her life.
I worry about my other kids, and my relationship with my best friend. I worry that I might write something on this blog that might offend my boss and get me in the crap shoot. I worry, like many do, that I might drop dead in a heart beat and never get to see my kids grow up.
Yet Matthew (Matthew 6 (24-34) writes that we should not be worried about the clothes we wear or the food we eat, "after all, isn't life worth more than food? And isn't the the body worth more than food?"
I think this passage might be one of my favorites in the Bible, and perhaps the most humbling. We sit around worrying about these little things in life that seem so big, yet as Matthew continues on, he explains that these things are always provided for by God, or by God's prophets. God will either provide these things, or one of his little helpers will come along and provide them for Him for you.
Likewise, he is also saying that there is something more important than anything you do in this life. There is something you should do before you do any worrying, and even before you do any good deed. Before you become the prophet of the Lord (which is what we RTs are in a way because we are helping people), you must first reaffirm your relationship with your God.
You must become one with God. You must reaffirm your values and virtues. You must think about:
Mother Theresa, before she would do any acts of goodness, would spend three hours in prayer every day. I wouldn't expect you or me to spend three hours in prayer, yet a moment of prayer in the morning is often all it takes. A moment in the morning, a moment before (or after) meals, and a moment before bed.
Once we have reaffirmed our faith, once we have reaffirmed our relationship with God (you can use God as a metaphor for the values listed above if you want), once we reaffirm with ourselves what our mission is in this life, once we reassure ourselves of our purpose, then and only then should you do anything else.
Yet you should not worry or be anxious. As Matthew explains, "Look at the birds: they do not plant seeds, gather a harvest and put it in barns: yet your Father in heaven takes care of them! Aren't you worth much more than birds? Can any of you live a bit longer by worrying about it?"
The answer is not. In fact, worrying is proven to take years off your life. Worrying causes ulcers and asthma and all sorts of bad stuff. Worrying causes many to resort to gluttony. It causes us to do things that feel pleasant but are unpleasant in the long run. A good example of this is the gluttony of yours truly when his first three children were in the making and were infants. It was easy to replace anxieties with food and drink.
Yet with the last child he did the opposite. While his while was pregnant, instead of resorting to gluttony and gaining weight with her, he did the Body for Life. It was a sacrifice and it was almost unpleasantly hard, yet the pleasures of that hard work are now paying off.
I remember when I was at National Jewish Hospital in 1985. The first three months were fine, because I was told I'd be home at the end of three months. Yet then I was told I would be there another three months after that. This effected me for the worse. I refused to talk to anyone. I became a lost in my own head. I became utterly depressed. Then I turned to God and reaffirmed my faith (I wrote about this here). I became closer to God than I ever had been before.
I think this faith lasted until about the year 2000 when I got my full time job working nights. I became so rapt in my own desires and my own family and my own self that I lost my way. Thankfully when I lost my way I'm not referring to doing anything terrible. Yet I felt as though I had lost my relationship with God. I hated my boss. I hated my job. I felt utterly miserable.
Yet after a while I decided it was time to return home. I missed the way I felt when I was close to God. I missed being that person who never cursed or never said anything negative. I missed being the person everyone looked up to. So I searched for God, and, as Isaiah wrote so many years ago, God was right there with open arms.
The neat thing, soon after I started reading the Bible every day and going to church every week, good things started to happen. Bad things happened in my life, and I didn't feel empty. I didn't blame God. My mother in law died and she was only 50, and I was able to cope with it quite well. I quit complaining at work (I wrote about this here), and the boss soon placed me in a more positive position within the department. People started looking up to me. People who used to hate me were now getting along with me.
I see something similar in my children. My grandma once said to me that you, as a dad, will be like a got to your children. I see what she means when I discipline my children. They hate me for a short time, and then an hour later they are my best friend again. They yearn for me to be with them.
Ironically, as the priest was discussing the above, my daughter was throwing a fit in church. She was refusing to sit and stand properly. She put her coat over hear head. When I returned to home I had no choice but to punish her to her room. Then I found a book of mine (Stephen Kings Full Dark, No Stars), and saw that it had been written on. It was my daughter's handwriting. It said, "I don't believe in god"
I usually view book desecration by kids a good thing. I think it makes the book more valuable. Yet what she wrote stung. It made me wonder about what is going on in her head. Yet then I think back to when I was an anxious kid, and how did I turn out? I turned out perfectly normal. God provided a normal life for me, so why not would God provide a normal life for my daughter.
So worry I quit. And an hour later my daughter was in the living room sitting next to me, giving me a big hug. She loved me, and I loved her back. God made us in His image. As my love for my daughter will never end, God's love for me will never end. When became lost and decided to be found, he was right there with open arms.
As Matthew continues, "So do not start worrying: 'Where will my food come from? or my drink? or my clothes? (These are things that the pagans are always worried about). Your father in heaven knows you need all of these things. Instead, be concerned about everything else with the Kingdom of God and with what he requires of you, and he will provide you with all these other things. So do not worry about tomorrow, it will have enough worries of its own. there is not need to add to the troubles each day brings."
We are all here in this life on a mission. We all have a purpose. Yet, we must prioritize. As Paul explains (Corinthians 4: 1-2), "You should think of us as Christ's servants, who have been in charge of god's secret truths. The one thing required of such a servant is that he be faithful to his master."
So we must re-confirm with ourselves the basics of life and what is important. We must remember our values. We must know what our mission on this earth is, and then and only then must we go out in the real world and do what we were born to do. In my case, I was born to spend time with sick people and blog. What were you born to do?
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Sometimes we become so wrapped up in our own anxieties that we leave God in search of answers somewhere else. We doubt that He exists. We feel as though he has abandoned us. Yet with a little soul searching, we usually find ourselves and, like the child who is away from his parents a long time, we yearn for their return.
Yet the Prophet Isaiah (Isaiah 49: 14-15), when the people of Israel felt anxiety and that God had abandoned them, explained, "Can a woman forget her own child, I will never forget you."
Likewise, when we feel anxiety, it's usually because we are worrying about things of which we have little control. We worry how we are to put food on the table, or the best clothing on our children. I presently worry that the mood changes that have effected my 7 year old after the death of her grandma and great grandma in the same day, might linger and effect the rest of her life.
I worry about my other kids, and my relationship with my best friend. I worry that I might write something on this blog that might offend my boss and get me in the crap shoot. I worry, like many do, that I might drop dead in a heart beat and never get to see my kids grow up.
Yet Matthew (Matthew 6 (24-34) writes that we should not be worried about the clothes we wear or the food we eat, "after all, isn't life worth more than food? And isn't the the body worth more than food?"
I think this passage might be one of my favorites in the Bible, and perhaps the most humbling. We sit around worrying about these little things in life that seem so big, yet as Matthew continues on, he explains that these things are always provided for by God, or by God's prophets. God will either provide these things, or one of his little helpers will come along and provide them for Him for you.
Likewise, he is also saying that there is something more important than anything you do in this life. There is something you should do before you do any worrying, and even before you do any good deed. Before you become the prophet of the Lord (which is what we RTs are in a way because we are helping people), you must first reaffirm your relationship with your God.
You must become one with God. You must reaffirm your values and virtues. You must think about:
Mother Theresa, before she would do any acts of goodness, would spend three hours in prayer every day. I wouldn't expect you or me to spend three hours in prayer, yet a moment of prayer in the morning is often all it takes. A moment in the morning, a moment before (or after) meals, and a moment before bed.
Once we have reaffirmed our faith, once we have reaffirmed our relationship with God (you can use God as a metaphor for the values listed above if you want), once we reaffirm with ourselves what our mission is in this life, once we reassure ourselves of our purpose, then and only then should you do anything else.
Yet you should not worry or be anxious. As Matthew explains, "Look at the birds: they do not plant seeds, gather a harvest and put it in barns: yet your Father in heaven takes care of them! Aren't you worth much more than birds? Can any of you live a bit longer by worrying about it?"
The answer is not. In fact, worrying is proven to take years off your life. Worrying causes ulcers and asthma and all sorts of bad stuff. Worrying causes many to resort to gluttony. It causes us to do things that feel pleasant but are unpleasant in the long run. A good example of this is the gluttony of yours truly when his first three children were in the making and were infants. It was easy to replace anxieties with food and drink.
Yet with the last child he did the opposite. While his while was pregnant, instead of resorting to gluttony and gaining weight with her, he did the Body for Life. It was a sacrifice and it was almost unpleasantly hard, yet the pleasures of that hard work are now paying off.
I remember when I was at National Jewish Hospital in 1985. The first three months were fine, because I was told I'd be home at the end of three months. Yet then I was told I would be there another three months after that. This effected me for the worse. I refused to talk to anyone. I became a lost in my own head. I became utterly depressed. Then I turned to God and reaffirmed my faith (I wrote about this here). I became closer to God than I ever had been before.
I think this faith lasted until about the year 2000 when I got my full time job working nights. I became so rapt in my own desires and my own family and my own self that I lost my way. Thankfully when I lost my way I'm not referring to doing anything terrible. Yet I felt as though I had lost my relationship with God. I hated my boss. I hated my job. I felt utterly miserable.
Yet after a while I decided it was time to return home. I missed the way I felt when I was close to God. I missed being that person who never cursed or never said anything negative. I missed being the person everyone looked up to. So I searched for God, and, as Isaiah wrote so many years ago, God was right there with open arms.
The neat thing, soon after I started reading the Bible every day and going to church every week, good things started to happen. Bad things happened in my life, and I didn't feel empty. I didn't blame God. My mother in law died and she was only 50, and I was able to cope with it quite well. I quit complaining at work (I wrote about this here), and the boss soon placed me in a more positive position within the department. People started looking up to me. People who used to hate me were now getting along with me.
I see something similar in my children. My grandma once said to me that you, as a dad, will be like a got to your children. I see what she means when I discipline my children. They hate me for a short time, and then an hour later they are my best friend again. They yearn for me to be with them.
Ironically, as the priest was discussing the above, my daughter was throwing a fit in church. She was refusing to sit and stand properly. She put her coat over hear head. When I returned to home I had no choice but to punish her to her room. Then I found a book of mine (Stephen Kings Full Dark, No Stars), and saw that it had been written on. It was my daughter's handwriting. It said, "I don't believe in god"
I usually view book desecration by kids a good thing. I think it makes the book more valuable. Yet what she wrote stung. It made me wonder about what is going on in her head. Yet then I think back to when I was an anxious kid, and how did I turn out? I turned out perfectly normal. God provided a normal life for me, so why not would God provide a normal life for my daughter.
So worry I quit. And an hour later my daughter was in the living room sitting next to me, giving me a big hug. She loved me, and I loved her back. God made us in His image. As my love for my daughter will never end, God's love for me will never end. When became lost and decided to be found, he was right there with open arms.
As Matthew continues, "So do not start worrying: 'Where will my food come from? or my drink? or my clothes? (These are things that the pagans are always worried about). Your father in heaven knows you need all of these things. Instead, be concerned about everything else with the Kingdom of God and with what he requires of you, and he will provide you with all these other things. So do not worry about tomorrow, it will have enough worries of its own. there is not need to add to the troubles each day brings."
We are all here in this life on a mission. We all have a purpose. Yet, we must prioritize. As Paul explains (Corinthians 4: 1-2), "You should think of us as Christ's servants, who have been in charge of god's secret truths. The one thing required of such a servant is that he be faithful to his master."
So we must re-confirm with ourselves the basics of life and what is important. We must remember our values. We must know what our mission on this earth is, and then and only then must we go out in the real world and do what we were born to do. In my case, I was born to spend time with sick people and blog. What were you born to do?
Saturday, January 28, 2012
Things to tell my great grand kids
I remember TVs with dials and phones with dials and cords. I remember metal hangers and cars that ran on gas. I remember when lawnmowers were loud and smelled of gas, and we men loved the smell and the noise.
I remember when cell phones were called car phones and were large and cumbersome, and the battery pack was stored in the trunk of the car and took up space. I remember taking typing class in the 10th grade and it was optional.
I remember the first computers that you pretty much had to write your own programs and they were used pretty much for games that didn't work. I remember the first video games for home called Atari and we were so excited about it even though the graphics sucked and the games weren't realistic.
I remember being in college and my teacher showing us how to use this thing called email and we kids thinking how stupid and useless it was for us to learn. I remember in the 1990s seeing commercials for .coms and thinking what a waste of time those commercials were because no one had computers anyway.
I remember not having a computer until 2000 because they were too expensive, and then being excited a few years later when we bought our second one for $200, and we got a big and thin screen to go with it. I remember in 2011 getting our first laptop and struggling to get used to it at the age of 41.
I remember watching on a black and white TV at school the take off and landing of the first space shuttle flight. I remember film projectors in class, and I remember we kids were excited when the teacher played the film backwards.
I remember in the 1970s riding a bike and getting my bell bottoms stuck in the spokes. I remember red white and blue socks and short shorts. I remember getting our first microwave in the mid 1980s and it was huge and had dials and then in the mid 80s renting a VCR so we could watch our first movie rental at home.
I remember tapes and CDs and tape players and CD players and CD/tape players and then disks and flash drives and then learning how to texts on cell phones you didn't have yet but everyone else did.
I remember when we finally splurged to get a VCR and then finally cable was wired to our street in 1987 when I was 17. I remember this new station called Fox had shows like the Simpsons and Married With Children and kids would talk about these shows. Later when we got cable we could watch them too.
I remember the pacer that was rejected and ten years later all cars resembled the car that was ahead of it's time. I remember the 4 wheel drive car the Eagle and Chryslers merger with some German company and the popular Eagle's image was destroyed and the car eventually taken off the market.
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I remember when cell phones were called car phones and were large and cumbersome, and the battery pack was stored in the trunk of the car and took up space. I remember taking typing class in the 10th grade and it was optional.
I remember the first computers that you pretty much had to write your own programs and they were used pretty much for games that didn't work. I remember the first video games for home called Atari and we were so excited about it even though the graphics sucked and the games weren't realistic.
I remember being in college and my teacher showing us how to use this thing called email and we kids thinking how stupid and useless it was for us to learn. I remember in the 1990s seeing commercials for .coms and thinking what a waste of time those commercials were because no one had computers anyway.
I remember not having a computer until 2000 because they were too expensive, and then being excited a few years later when we bought our second one for $200, and we got a big and thin screen to go with it. I remember in 2011 getting our first laptop and struggling to get used to it at the age of 41.
I remember watching on a black and white TV at school the take off and landing of the first space shuttle flight. I remember film projectors in class, and I remember we kids were excited when the teacher played the film backwards.
I remember in the 1970s riding a bike and getting my bell bottoms stuck in the spokes. I remember red white and blue socks and short shorts. I remember getting our first microwave in the mid 1980s and it was huge and had dials and then in the mid 80s renting a VCR so we could watch our first movie rental at home.
I remember tapes and CDs and tape players and CD players and CD/tape players and then disks and flash drives and then learning how to texts on cell phones you didn't have yet but everyone else did.
I remember when we finally splurged to get a VCR and then finally cable was wired to our street in 1987 when I was 17. I remember this new station called Fox had shows like the Simpsons and Married With Children and kids would talk about these shows. Later when we got cable we could watch them too.
I remember the pacer that was rejected and ten years later all cars resembled the car that was ahead of it's time. I remember the 4 wheel drive car the Eagle and Chryslers merger with some German company and the popular Eagle's image was destroyed and the car eventually taken off the market.
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Friday, January 27, 2012
How to introduce yourself to a patient?
Your humble question: What is the best way to introduce yourself to a patient and to identify the patient without breaking confidentiality rules?
My humble answer: There really is no rule how to introduce yourself. However, due to confidentiality laws (like HIPPA) I find it's best never to say the name of the patient. My technique is to get the patient to say his or her name so I don't have to. I usually do the following:
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My humble answer: There really is no rule how to introduce yourself. However, due to confidentiality laws (like HIPPA) I find it's best never to say the name of the patient. My technique is to get the patient to say his or her name so I don't have to. I usually do the following:
- I pick up the written (printed) order and take it with me to the room
- I always introduce myself as I enter the room: "Hi, I'm Rick from respiratory therapy."
- Then I say something like, "Will you please say your last name?"
- I confirm the last name with the order and I say the first name of the patient. Or, if I'm in a humorous mood, I'll say something like, "Yeah, you're right?" Or I say something like, "Yep, you're the right patient." You can get creative once you know you have the right patient.
- Or... if the patient is unable to communicate you can always check the wrist band, or follow the above procedure with the family member or guardian.
Thursday, January 26, 2012
It's good that we are here
I've seen death for what it really is. I've seen the road to death. Yet what impresses me more than anything is when a person who is closing in on the pearly gates is okay by it. I was reminded of this the other day as I entered the room of a 100-year-old man and he smiled.
He was among the most pleasant patients I've ever had. His smile was bright and cheery as my 2-year-olds. His vision of death perhaps the same. He's obviously seen much, and most of those he has spent his time with are now gone.
Yet here he is sitting in this recliner, most of his teeth dark, his skin cracked and wrinkled, his hair white and barely visible along the sides of his head, yet in the moment he is happy he is here. He has been humbled like no other man in the hospital. He has seen more misery. He has seen more happiness. He has seen more than the 22-year-old man in the room next to him who was crying and agitated because he had to spend "one more night in this dump."
He spoke little. He closed his eyes when you weren't speaking to him, and when you spoke he opened his eyes and listened. I was most impressed by this, considering his old ears could still hear, and his eyes could still see, so long as he had his glasses on.
What more did he have to say. Most people try to accomplish their goals in life, and to share their stories, by the time the predict they will die (some think they will live forever). I notice COPD patients are often quite willing to talk and to share their life stories. I've decided they've come to terms that they will die some day, that they will not escape the grim reaper's grip.
Yet when one is 100 years old, they have accomplished any goals they have set for their life, perhaps several years earlier. They have shared all their stories. I've rarely met an 80 year old who believes he has nothing else to offer in this world, yet I believe most of us don't expect to be around at 100. Few of us will be on the journey this long. It's a rare feet.
Yet he was happy in the moment. He was happy he was here. It sort of reminded me of the story that Matthew told in the Bible about how Peter, James and John see Jesus transfigured, his face white as the sun, as he is talking with Moses and Elijah. They saw Jesus transfigured on Mount Tabor in all his glory, as he truly is.
So Peter says, "It's good that we are here." He says this about the moment. He knows he's going to have many trials and trivializations the rest of his life. He does, as the Bible tells, reject Jesus three times before Jesus dies. Yet he is happy in the moment. He, in essence, has stopped to smell the roses.
Seeing the 100 year old man made me want to stop and re-evaluate my life. Am I truly happy where I am at? Or am I like the majority of people who spend their entire lives trying to obtain some goal, perhaps something trivial for material gain, and who fails to enjoy what life offers in every moment?
I do think of this often, and perhaps it's a gift because I have asthma and have been close to death's door a time or two as a kid. I think often that my 12-year-old will only be living with us five more years, and my parents won't life forever. And that, perhaps, is why I make sure to go to Florida every winter to visit my parents and go to Disney, even though I'm otherwise frugal with my money.
So in the moment I am happy. I think of this even as I worked my ass off at work the past two days, perhaps doing the work of two or three RTs, and yet when I arrived at work on Tuesday my boss lectured me about how I need to start picking up after myself, and stop leaving my coffee and water cups lying around. I believe he is not happy he is here.
And after a miserable day at work like that, I go home and hug my kids and roll around the floor with them. I am happy in the moment. I am happy I am here.
Do you ever have a moment where you think to yourself, "It's good that we are here?"
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He was among the most pleasant patients I've ever had. His smile was bright and cheery as my 2-year-olds. His vision of death perhaps the same. He's obviously seen much, and most of those he has spent his time with are now gone.
Yet here he is sitting in this recliner, most of his teeth dark, his skin cracked and wrinkled, his hair white and barely visible along the sides of his head, yet in the moment he is happy he is here. He has been humbled like no other man in the hospital. He has seen more misery. He has seen more happiness. He has seen more than the 22-year-old man in the room next to him who was crying and agitated because he had to spend "one more night in this dump."
He spoke little. He closed his eyes when you weren't speaking to him, and when you spoke he opened his eyes and listened. I was most impressed by this, considering his old ears could still hear, and his eyes could still see, so long as he had his glasses on.
What more did he have to say. Most people try to accomplish their goals in life, and to share their stories, by the time the predict they will die (some think they will live forever). I notice COPD patients are often quite willing to talk and to share their life stories. I've decided they've come to terms that they will die some day, that they will not escape the grim reaper's grip.
Yet when one is 100 years old, they have accomplished any goals they have set for their life, perhaps several years earlier. They have shared all their stories. I've rarely met an 80 year old who believes he has nothing else to offer in this world, yet I believe most of us don't expect to be around at 100. Few of us will be on the journey this long. It's a rare feet.
Yet he was happy in the moment. He was happy he was here. It sort of reminded me of the story that Matthew told in the Bible about how Peter, James and John see Jesus transfigured, his face white as the sun, as he is talking with Moses and Elijah. They saw Jesus transfigured on Mount Tabor in all his glory, as he truly is.
So Peter says, "It's good that we are here." He says this about the moment. He knows he's going to have many trials and trivializations the rest of his life. He does, as the Bible tells, reject Jesus three times before Jesus dies. Yet he is happy in the moment. He, in essence, has stopped to smell the roses.
Seeing the 100 year old man made me want to stop and re-evaluate my life. Am I truly happy where I am at? Or am I like the majority of people who spend their entire lives trying to obtain some goal, perhaps something trivial for material gain, and who fails to enjoy what life offers in every moment?
I do think of this often, and perhaps it's a gift because I have asthma and have been close to death's door a time or two as a kid. I think often that my 12-year-old will only be living with us five more years, and my parents won't life forever. And that, perhaps, is why I make sure to go to Florida every winter to visit my parents and go to Disney, even though I'm otherwise frugal with my money.
So in the moment I am happy. I think of this even as I worked my ass off at work the past two days, perhaps doing the work of two or three RTs, and yet when I arrived at work on Tuesday my boss lectured me about how I need to start picking up after myself, and stop leaving my coffee and water cups lying around. I believe he is not happy he is here.
And after a miserable day at work like that, I go home and hug my kids and roll around the floor with them. I am happy in the moment. I am happy I am here.
Do you ever have a moment where you think to yourself, "It's good that we are here?"
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Wednesday, January 25, 2012
Doctor Lexicon
The Doctor Lexicon:
1. Stupid doctor orders: Doctor Orders written based on habit and with no scientifically proven value; doctor orders that are based on antediluvian theories.
2. Normal doctor orders: Doctor Orders written based on scientific evidence
3. Antediluvian theories: Theories that are old and outdated yet are still worshipped by doctors like the hypoxic drive theory.
4. Regular theories: Based on a rational guess
5. Scientific fact: Proven by science
6. Unfettered Doctor Power: Power doctors were given by people who refuse to question them. Power derived by patients who think doctors know everything. Power obtained because respiratory therapists find it easier to just do what the doctor said as opposed to questioning orders. Power obtained by RT Bosses who choose to place doctors on a higher eschelon than the respiratory therapists they represent. This is how we end up with bronchodilator abuse and stupid doctor orders.
5. Doctor Enabling: 1) Often results from Unfettered Doctor Power. Lack of questioning one person's authority results in that person abusing his power. It results in unnecessary breathing treatments, unnecessary nursing home stays, and other stupid doctor orders, etc. 2) Both patients and medical staff enable doctors to get away with anything they want. This breeds ego.
6. Doctor Ego: When a doctor's head swells to the size of a watermellon because he thinks he knows all and is never questioned by anyone because he has a nasty temper and is feared.
7. Bronchodilator abuse: When doctors order breathing treatments nonscientific reasons; ordering treatments just to cover their bases; ordering treatments just to make sure reimbursement criteria is met; treating all annoying lung sounds and all dyspnea with bronchodilator breathing treatments
8. Elitist Doctors: Doctors who think they are above and beyond every other person. They believe they know it all; Doctor ego; Unfettered Doctor power; Enabling. They have become totalitarian. They are able to do without being questioned. Doctors that haven't been questioned for so long they start to treat people like truck engines on an assembly line instead of as people.
9. Bronchodilator abuse: When doctors order breathing treatments nonscientific reasons; ordering treatments just to cover their bases; ordering treatments just to make sure reimbursement criteria is met; treating all annoying lung sounds and all dyspnea with bronchodilator breathing treatments
10. Covering your bases: 1) The silly idea that simply ordering a breathing treatment so the family thinks you're doing something, you're in the right. That ordering an $80 a pop treatment every four hours you're in the right. 2) Obviously if you throw everything at every patient you're going to hit on something and the patient will eventually get better.
11. Hoaxanex: The belief that Xopenex is somehow stronger and better than Albuterol
12. Hypoxic Drive Hoax: A theory postulated back in the 1930s when RTs were desperate to prove to doctors they were a useful profession. Now that the theory has been debunked we can't get doctors to quit believing in it. It's the belief you need to decrease oxygen when the PO2 is 86% or above. It's an excuse to make doctors not liable for keeping patients in a hypoxic environment. See Faux Confidence.
13. Hypoxic Drive Theory: A theory which states COPD retainers use oxygen as their drive to breathe and not CO2. It's debunked on a daily basis but most doctors don't care. See hypoxic drive hoax.
14. Respiratory Therapists: The people doctors call when they don't feel like thinking.
15. Albuterol: 1) Something doctors order when they don't know what else to do; It's what's ordered instead of using science. See covering your bases, bronchodilator. 2) The cheapest and most common bronchodilator. A medicine doctors think is the Tylenol for lungs. Holy water. Scrubbin-bubbles.
16. Real Doctor's Creed: A document doctors vow to uphold in leu of using science in order to make their job easier, cover their bases, and piss off RTs.
17. Bronchodilator idealists: Doctors and nurses who believe bronchodilators will lead to world peace and perfect health despite science to the contrary. They will say they have the truth on their side, yet when you tell them to "prove it!" they get all upset and start to quiver in their pants. They do this because they know there is no proof to what they are proposing. There is the history of stupid bronchodilator orders that's for sure, but there is no evidence to back up the reason for all these orders. You'll even see insurance companies allowing breathing treatments to meet admission criteria because some doctor said this is what will help them get better quicker, but there is no real proof to back up that bronchodilators do any good for anything other than (ahem) bronchospasm.
18. Idealist Doctor: they believe that a perfect healthcare system where everyone receives equal health care at equal costs, and that all patients will a particular DRG can be treated the same. They incorporate order sets. They shun individual thought. They throw temper tantrums when you question them. They believe bronchodilators work for all wheezes and dyspnea. Idealists will tell you bronchodilators work for all that wheezes, or for all annoying lung sounds, or for all lung diseases
19. Realist Doctor: They understand a perfect healthcare system isn't possible. They understand you can't treat all patients the same. They understand they don't know everything. They yearn for teamwork and are willing to give up autonomy for the benefit of the patient. They write orders based on science and create policies to encourage individual choice such as protocols that allow RTs to made point of care decisions to the benefit of the patient, RT, doctor and hospital. They understand bronchodilators dilate bronchioles and don't order them on all patients unless the hospital makes them by initiating idealist doctor driven order sets. The realist at the bedside giving the treatment sees the truth, that the treatment did nothing.
20. Science: It's proven to work. It's based on fact. Bronchodilators dilate bronchioles is a fact.
21. Fallacy: It's not based on science. It's not a fact. Bronchodilators will cure all lung ailments and annoying lung sounds is a fallacy.
22. Malady: A disease
23. Myth: See fallacy.
24. Bronchodilators: 1) Broncho - lung air passages. Dilator = opens up the airway to make air flow through them better. They relax smooth muscles that are squeezing the bronchiole passages and thus cause these muscles to relax. Bronchodilators treat bronchospasm. They relax the air passages. They dilate the air passages. 2) The cure for all lung dyspnea and annoying lung sounds.
25. Tylenol: Analgesic. Pain reliever. Fever reducer. Doctors think it treats every other ailment too. When all else fails order Tylenol. It's the worlds most euphoric medicine. Ideal medicine. Cure all. Holy pill.
26. Scrubbin Bubbles: The belief Albuterol will turn into suds and wash all the shit out of the lungs and cure them of all ailments like in that commercial for scrubbin bubbles foaming action.
Two basic Types:
1. Gallant Doctor: Gallant Doctor: This doctor knows how to take care of your asthma the right way. He keeps up to date on asthma wisdom, and goes out of his way to make sure you are well educated and on all the best medicines for you. He also works with you on a good Asthma Action Plan, and makes sure you feel comfortable knowing you can call him at any time. He also makes sure you schedule an appointment to see him every six months. Asthmatics who see Gallant doctors have the best chance of having well-controlled asthma. Thankfully, a majority of asthma doctors are this type.
2. Goofus Doctor: Whatever he learned in school umpteen years ago is exactly what he uses to care for you today. He's either too busy, lazy or sometimes simply too arrogant to stay up-to-date on the latest asthma wisdom. He will allow you to walk out of his office with only a rescue inhaler. Asthmatics who have Goofus doctors are Poor Patient Asthmatics who have a tendency to make unscheduled office visits, or trips to the ER, and are often mistaken as Goofus Asthmatics.
Generally, all doctors are either a Goofus or Gallant, but there are sub types of each Asthma doctor personality. Below are all subtypes of the Gallant Asthma Doctor:
1. The Gallants: Strong, Silent Type: She never gets excited, and has a ho hum or gloomy disposition. She often has a finger on her forehead and says, "Hmmm, I wonder..." She is well kempt, organized, jots a lot of notes and knows her stuff. She is very quiet and doesn't like to participate in small talk, but when it comes to asthma or your health she'll talk fluently. She'll assess you thoroughly while remaining taciturn. You might be intimidated by the silence, but she doesn't mean for you to feel uncomfortable. She's very friendly and polite, but also straightforward. She may also ask for your opinion, which may have you wondering if she knows what she's talking about. However, her intention is to involve you in the decision making. She will make sure you are well prepared and cared for upon leaving her office, but once she finishes the job, she will up and leave without shaking your hand or saying good-bye. While she's socially gauche with poor bedside manners, if you like a knowledgeable doc, she's the one for you.
2. Big Hearted Bully: Although he has the bedside manner of a rock and refuses to participate in small talk, he might simply be the best doctor in the world. He is focused and the key for you is to put up with his bluntness and his seeming arrogance. He does not go into detail as he expects you to do your own homework. He usually answers questions with one or two words and, sometimes, he simply grunts. If you annoy him with your petty questions, he'll grimace and moan. If you try to make suggestions, he'll intimidate you with his stare. Yes, you will get a thorough workup and he will take good care of you. If you call him with an asthma concern, he will go out of his way to meet you at the office. He's the only doctor type who will never write a prescription without seeing you first. His decisiveness and stubbornness may impress you, or it may vex you. Overall, if you are the kind of patient who likes a doctor to take control, he's your doc.
3. Columbo: She has a very friendly, nonchalant disposition and quite often has ruffled hair, with an overall disheveled disposition like the 1970s TV detective Columbo (collars up, tie crooked, spot of jelly on white lab coat). When things go wrong she scratches her head with an unreadable expression. She'll slouch in her chair with her legs crossed. She's been known to say things like, "Well, what do you suggest we do today?" Or, "What medicines would you like to try?" When you call her, she's the doc who asks, "Do you think you should come in to see me?" Or, if she meets you in the ER, she may ask, "Do you think you should be admitted?" After a while, you wonder if you are the doctor or if she is. On the other hand, if you are the kind of patient who likes to have more control, this might be the ideal doctor for you.
4. The Buddy: He's the doctor who is often late for your appointments. Even though your irritation level reaches its peak, when he finally does arrive, he cracks a joke you can't help laughing at. He's an amazingly happy person and has a knack for telling stories, especially when you are in an inconvenient position (like on the colonoscopy table, or with your mouth stuffed in the dentist chair). He has a positive disposition and can get you excited even about diseases you might have -- like asthma. He often downplays severity by saying things like, "Oh, you'll be fine," or, "I wouldn't worry about it if I were you." You might catch him saying something goofy like, "Well, today we're going to come up with the perfect concoction to fix you." Yet, if you can tolerate his sunny disposition, you'll participate in an awesome discussion unrelated to asthma. You may actually leave the office feeling like you learned more about his life than about asthma. Despite his quirks, you know he's taking great care of your asthma. So, if you like a friendly, upbeat person, he's your doc.
Along with being a Goofus or a Gallant, each doctor will have one of the following traits:
1. Stupid doctor orders: Doctor Orders written based on habit and with no scientifically proven value; doctor orders that are based on antediluvian theories.
2. Normal doctor orders: Doctor Orders written based on scientific evidence
3. Antediluvian theories: Theories that are old and outdated yet are still worshipped by doctors like the hypoxic drive theory.
4. Regular theories: Based on a rational guess
5. Scientific fact: Proven by science
6. Unfettered Doctor Power: Power doctors were given by people who refuse to question them. Power derived by patients who think doctors know everything. Power obtained because respiratory therapists find it easier to just do what the doctor said as opposed to questioning orders. Power obtained by RT Bosses who choose to place doctors on a higher eschelon than the respiratory therapists they represent. This is how we end up with bronchodilator abuse and stupid doctor orders.
5. Doctor Enabling: 1) Often results from Unfettered Doctor Power. Lack of questioning one person's authority results in that person abusing his power. It results in unnecessary breathing treatments, unnecessary nursing home stays, and other stupid doctor orders, etc. 2) Both patients and medical staff enable doctors to get away with anything they want. This breeds ego.
6. Doctor Ego: When a doctor's head swells to the size of a watermellon because he thinks he knows all and is never questioned by anyone because he has a nasty temper and is feared.
7. Bronchodilator abuse: When doctors order breathing treatments nonscientific reasons; ordering treatments just to cover their bases; ordering treatments just to make sure reimbursement criteria is met; treating all annoying lung sounds and all dyspnea with bronchodilator breathing treatments
8. Elitist Doctors: Doctors who think they are above and beyond every other person. They believe they know it all; Doctor ego; Unfettered Doctor power; Enabling. They have become totalitarian. They are able to do without being questioned. Doctors that haven't been questioned for so long they start to treat people like truck engines on an assembly line instead of as people.
9. Bronchodilator abuse: When doctors order breathing treatments nonscientific reasons; ordering treatments just to cover their bases; ordering treatments just to make sure reimbursement criteria is met; treating all annoying lung sounds and all dyspnea with bronchodilator breathing treatments
10. Covering your bases: 1) The silly idea that simply ordering a breathing treatment so the family thinks you're doing something, you're in the right. That ordering an $80 a pop treatment every four hours you're in the right. 2) Obviously if you throw everything at every patient you're going to hit on something and the patient will eventually get better.
11. Hoaxanex: The belief that Xopenex is somehow stronger and better than Albuterol
12. Hypoxic Drive Hoax: A theory postulated back in the 1930s when RTs were desperate to prove to doctors they were a useful profession. Now that the theory has been debunked we can't get doctors to quit believing in it. It's the belief you need to decrease oxygen when the PO2 is 86% or above. It's an excuse to make doctors not liable for keeping patients in a hypoxic environment. See Faux Confidence.
13. Hypoxic Drive Theory: A theory which states COPD retainers use oxygen as their drive to breathe and not CO2. It's debunked on a daily basis but most doctors don't care. See hypoxic drive hoax.
14. Respiratory Therapists: The people doctors call when they don't feel like thinking.
15. Albuterol: 1) Something doctors order when they don't know what else to do; It's what's ordered instead of using science. See covering your bases, bronchodilator. 2) The cheapest and most common bronchodilator. A medicine doctors think is the Tylenol for lungs. Holy water. Scrubbin-bubbles.
16. Real Doctor's Creed: A document doctors vow to uphold in leu of using science in order to make their job easier, cover their bases, and piss off RTs.
17. Bronchodilator idealists: Doctors and nurses who believe bronchodilators will lead to world peace and perfect health despite science to the contrary. They will say they have the truth on their side, yet when you tell them to "prove it!" they get all upset and start to quiver in their pants. They do this because they know there is no proof to what they are proposing. There is the history of stupid bronchodilator orders that's for sure, but there is no evidence to back up the reason for all these orders. You'll even see insurance companies allowing breathing treatments to meet admission criteria because some doctor said this is what will help them get better quicker, but there is no real proof to back up that bronchodilators do any good for anything other than (ahem) bronchospasm.
18. Idealist Doctor: they believe that a perfect healthcare system where everyone receives equal health care at equal costs, and that all patients will a particular DRG can be treated the same. They incorporate order sets. They shun individual thought. They throw temper tantrums when you question them. They believe bronchodilators work for all wheezes and dyspnea. Idealists will tell you bronchodilators work for all that wheezes, or for all annoying lung sounds, or for all lung diseases
19. Realist Doctor: They understand a perfect healthcare system isn't possible. They understand you can't treat all patients the same. They understand they don't know everything. They yearn for teamwork and are willing to give up autonomy for the benefit of the patient. They write orders based on science and create policies to encourage individual choice such as protocols that allow RTs to made point of care decisions to the benefit of the patient, RT, doctor and hospital. They understand bronchodilators dilate bronchioles and don't order them on all patients unless the hospital makes them by initiating idealist doctor driven order sets. The realist at the bedside giving the treatment sees the truth, that the treatment did nothing.
20. Science: It's proven to work. It's based on fact. Bronchodilators dilate bronchioles is a fact.
21. Fallacy: It's not based on science. It's not a fact. Bronchodilators will cure all lung ailments and annoying lung sounds is a fallacy.
22. Malady: A disease
23. Myth: See fallacy.
24. Bronchodilators: 1) Broncho - lung air passages. Dilator = opens up the airway to make air flow through them better. They relax smooth muscles that are squeezing the bronchiole passages and thus cause these muscles to relax. Bronchodilators treat bronchospasm. They relax the air passages. They dilate the air passages. 2) The cure for all lung dyspnea and annoying lung sounds.
25. Tylenol: Analgesic. Pain reliever. Fever reducer. Doctors think it treats every other ailment too. When all else fails order Tylenol. It's the worlds most euphoric medicine. Ideal medicine. Cure all. Holy pill.
26. Scrubbin Bubbles: The belief Albuterol will turn into suds and wash all the shit out of the lungs and cure them of all ailments like in that commercial for scrubbin bubbles foaming action.
27. Annoying Lung Sounds: Sounds doctors and nurses don't like. Sounds that cause fear and make nurses and doctors worry about the patient. Any lung noise audible or silent that causes the doctor to require thought.
28. Thought: Call RT
29. Autonomy: The yearning for total control.
30. Team work: Giving up autonomy. Understanding you don't know everything and can't do everything on your own. It's working together to solve a problem.
31. Ignorance: It's what you don't know. It's not a bad thing so long as you admit what you don't know.
32. Bronchodilator lies: Convincing yourself that bronchodilators treat everything, and every theory that disproves your belief is ignored.
33. Fake Diagnosis: So you're scheduled for a pulmonary function test (PFT), yet your diagnosis is diabetes. The doctor knows most insurance companies only cover PFTs if the diagnosis is COPD, cystic fibrosis, or asthma. Even though your doctor obviously thinks you need a PFT, your insurance won't cover it unless he lies. This should explain why on the PFT order form he gave you to take to the hospital it has "asthma" on the line next to diagnosis instead of diabetes.
34. To cover their asses: Doctors don't want to be sued, so they order whatever they think is needed so it looks like they did their best. Much of what we do in the hospital has no medical benefit whatsoever, and the only reason we do it is becasue the doctor wanted to cover his own butt from potential litigation.
35. Habit: orders: Doctors have a set list of things they order for each diagnosis. After a while he simply writes orders based on habit and may not even know what he wrote. For example, we have one doctor who orders breathing treatments for all his post operative patients. I asked him why he writes this order once and he said, "What's a breathing treatment?" Yet he continues to write the order. It's for this same reason many foley catheters are inserted into patients and other invasive procedures performed. Since no one questions the doctor, he has no incentive to update his ordering habits.
33. Fake Diagnosis: So you're scheduled for a pulmonary function test (PFT), yet your diagnosis is diabetes. The doctor knows most insurance companies only cover PFTs if the diagnosis is COPD, cystic fibrosis, or asthma. Even though your doctor obviously thinks you need a PFT, your insurance won't cover it unless he lies. This should explain why on the PFT order form he gave you to take to the hospital it has "asthma" on the line next to diagnosis instead of diabetes.
34. To cover their asses: Doctors don't want to be sued, so they order whatever they think is needed so it looks like they did their best. Much of what we do in the hospital has no medical benefit whatsoever, and the only reason we do it is becasue the doctor wanted to cover his own butt from potential litigation.
35. Habit: orders: Doctors have a set list of things they order for each diagnosis. After a while he simply writes orders based on habit and may not even know what he wrote. For example, we have one doctor who orders breathing treatments for all his post operative patients. I asked him why he writes this order once and he said, "What's a breathing treatment?" Yet he continues to write the order. It's for this same reason many foley catheters are inserted into patients and other invasive procedures performed. Since no one questions the doctor, he has no incentive to update his ordering habits.
1. Gallant Doctor: Gallant Doctor: This doctor knows how to take care of your asthma the right way. He keeps up to date on asthma wisdom, and goes out of his way to make sure you are well educated and on all the best medicines for you. He also works with you on a good Asthma Action Plan, and makes sure you feel comfortable knowing you can call him at any time. He also makes sure you schedule an appointment to see him every six months. Asthmatics who see Gallant doctors have the best chance of having well-controlled asthma. Thankfully, a majority of asthma doctors are this type.
2. Goofus Doctor: Whatever he learned in school umpteen years ago is exactly what he uses to care for you today. He's either too busy, lazy or sometimes simply too arrogant to stay up-to-date on the latest asthma wisdom. He will allow you to walk out of his office with only a rescue inhaler. Asthmatics who have Goofus doctors are Poor Patient Asthmatics who have a tendency to make unscheduled office visits, or trips to the ER, and are often mistaken as Goofus Asthmatics.
Generally, all doctors are either a Goofus or Gallant, but there are sub types of each Asthma doctor personality. Below are all subtypes of the Gallant Asthma Doctor:
1. The Gallants: Strong, Silent Type: She never gets excited, and has a ho hum or gloomy disposition. She often has a finger on her forehead and says, "Hmmm, I wonder..." She is well kempt, organized, jots a lot of notes and knows her stuff. She is very quiet and doesn't like to participate in small talk, but when it comes to asthma or your health she'll talk fluently. She'll assess you thoroughly while remaining taciturn. You might be intimidated by the silence, but she doesn't mean for you to feel uncomfortable. She's very friendly and polite, but also straightforward. She may also ask for your opinion, which may have you wondering if she knows what she's talking about. However, her intention is to involve you in the decision making. She will make sure you are well prepared and cared for upon leaving her office, but once she finishes the job, she will up and leave without shaking your hand or saying good-bye. While she's socially gauche with poor bedside manners, if you like a knowledgeable doc, she's the one for you.
2. Big Hearted Bully: Although he has the bedside manner of a rock and refuses to participate in small talk, he might simply be the best doctor in the world. He is focused and the key for you is to put up with his bluntness and his seeming arrogance. He does not go into detail as he expects you to do your own homework. He usually answers questions with one or two words and, sometimes, he simply grunts. If you annoy him with your petty questions, he'll grimace and moan. If you try to make suggestions, he'll intimidate you with his stare. Yes, you will get a thorough workup and he will take good care of you. If you call him with an asthma concern, he will go out of his way to meet you at the office. He's the only doctor type who will never write a prescription without seeing you first. His decisiveness and stubbornness may impress you, or it may vex you. Overall, if you are the kind of patient who likes a doctor to take control, he's your doc.
3. Columbo: She has a very friendly, nonchalant disposition and quite often has ruffled hair, with an overall disheveled disposition like the 1970s TV detective Columbo (collars up, tie crooked, spot of jelly on white lab coat). When things go wrong she scratches her head with an unreadable expression. She'll slouch in her chair with her legs crossed. She's been known to say things like, "Well, what do you suggest we do today?" Or, "What medicines would you like to try?" When you call her, she's the doc who asks, "Do you think you should come in to see me?" Or, if she meets you in the ER, she may ask, "Do you think you should be admitted?" After a while, you wonder if you are the doctor or if she is. On the other hand, if you are the kind of patient who likes to have more control, this might be the ideal doctor for you.
4. The Buddy: He's the doctor who is often late for your appointments. Even though your irritation level reaches its peak, when he finally does arrive, he cracks a joke you can't help laughing at. He's an amazingly happy person and has a knack for telling stories, especially when you are in an inconvenient position (like on the colonoscopy table, or with your mouth stuffed in the dentist chair). He has a positive disposition and can get you excited even about diseases you might have -- like asthma. He often downplays severity by saying things like, "Oh, you'll be fine," or, "I wouldn't worry about it if I were you." You might catch him saying something goofy like, "Well, today we're going to come up with the perfect concoction to fix you." Yet, if you can tolerate his sunny disposition, you'll participate in an awesome discussion unrelated to asthma. You may actually leave the office feeling like you learned more about his life than about asthma. Despite his quirks, you know he's taking great care of your asthma. So, if you like a friendly, upbeat person, he's your doc.
Along with being a Goofus or a Gallant, each doctor will have one of the following traits:
5.Totolitarian doctors: These are physicians who believe they know what's best for the patient and no one else's opinion matters. They do not like protocols because these allow other members of the care team to make decisions that might not be best for the patient. They do like order sets. These doctors have a tendency to get angry when things don't go their way.
6. Capitalist doctors: These are physicians who know they don't know everything and like to work with a team approach to benefit the patient. They encourage nurses and RTs to make individual decisions at the bedside, and respect the individual opinions and choices of other members of the patient care team. They like guidelines and protocols. These doctors are less likely to get angry because they are more open minded.
7. Order set doctor: A doctor who orders everything he can possibly think of. He fills out every order set possible with the hope that something -- anything -- will work. He covers all his bases by ordering as many procedures as possible. Yes there will be duplicate orders and even triplicate orders. Yes the unit secretary will go bonkers trying to sort it all out, and the nurses and respiratory therapists will snivel about doing all the "useless" stuff. But that doesn't matter because the theory is that if you throw everything at the patient, something is bound to work.
7. Order set doctor: A doctor who orders everything he can possibly think of. He fills out every order set possible with the hope that something -- anything -- will work. He covers all his bases by ordering as many procedures as possible. Yes there will be duplicate orders and even triplicate orders. Yes the unit secretary will go bonkers trying to sort it all out, and the nurses and respiratory therapists will snivel about doing all the "useless" stuff. But that doesn't matter because the theory is that if you throw everything at the patient, something is bound to work.
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