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Friday, March 4, 2011

bronchodilator honesty

So you've come to the realization that 90% of all bronchodilator breathing treatments ordered in the hospital are not-indicated and of no benefit to the patient. Yet what do you say when the patient, or the patient's daughter, says, "Do you think these treatments are doing anything?"

Or maybe the patient asks something like, "What are these treatments doing for me?" Do you tell the truth: "Nothing! They are useless!" Or do you lie, "They are making it easier for your father to breathe."

In good conscience, and as a good Christian, I find I'm unable to lie to my patients. So I kind of take the middle road to the above answers. I usually give them the political answer, something like:

"Well, if your father is having bronchospasms this medicine will probably make it easier for him to breathe. This is where the air passages in his lungs, " here I make a circle with my palm and fingers, "tighten," I make the circumference of my fingers smaller representing narrowing, "this medicine will work. This is basically an asthma attack. This is an asthma medicine. So, if this is what's happening in your father's lungs, this medicine will work.

"So," I continue --responses that circumvent the truth are always long -- "your doctor must believe this is happening, and I presume why he ordered treatments. Whether he's right or not it's hard to tell. Yet breathing treatments are very safe, so it's something worth trying."

Then I pause, and if I think the patient is intelligent, i add, "However, I see no evidence of this."

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