So I had a patient who has asthma. He told me he wondered why he couldn't just get an inhaler like he has at home so he can just use it when he needs it.
He said, "Are there any studies that prove a nebulizer is better than an MDI?"
I said, "No. In fact, all studies I've ever seen show that so long as you are not labored an MDI with spacer is equally as effective as a nebulizer." I told him he ought to share this fact with his doctor, and request an MDI.
He did. When I came in tonight his order was changed from Q6 to Q4. Which kind of made me laugh, because this is exactly what I wrote about in "Real Doctor's Creed."
"If RRT annoys you, change Albuterol to Xoponex Q3-4, Atrovent Q6, and consider using Pulmicort, Intal and/or Mucomyst. This will make tx last forever (tee hee hee)."
In this case it wasn't RT, it was the patient who asked. However the doctor must have caught on that RT was educating behind his back.