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Saturday, March 14, 2009

The common sense approach to hard luck asthma

A hard luck asthma patient came to see me in the ER last night. She had asthma so bad she actually spent some time at National Jewish recently (she hated the place). Since I was an asthma patient there in 1985 for six months, we had a nice chat.

That aside, after several breathing treatments I found myself standing behind the nurses station. The doctor (Dr. Q1) was concerned by something the patient said to her, which was this: "I gave myself 25 mg of solumedrol 2 days ago, and today I put myself on 80mg. Obviously it didn't work."

The doctor said to me, "She shouldn't be medicating herself like that without a doctor's order."

"Why not," I said. "I used to do that when my asthma was bad every day."

"You used to abuse your medicine?" Her stare was blank.

"Is it abuse?"

"Well yes it's abuse."

"I used to adjust medicine when I was having trouble breathing. If I didn't do things like that I would have ended up in the ER every week of my life. And since I'm not on welfare, I can't afford that. "

"But that's against the asthma guidelines."

"No it's not. The asthma guidelines are guidelines. They also recommend the doctor and patient work together on developing an asthma action plan individualized for the asthma patient. There are some hard luck asthmatics who can be trusted to treat themselves at home. When the said treatment doesn't work, they come to the ER -- like this patient did."

"I don't like that," the ER doc said.

There are many asthma action plans that allow for asthmatics to have a prescription of oral corticosteroids to keep in the medicine cabinet. When the asthma flares up the patient may self medicate and call the doctor.

If it works the patient avoids another expensive hospital visit. If it doesn't, then the patient has someone drive her to the ER, which is exactly what my patient did last night.

I respect Dr. Q1 in that she does a great job with her patients. But her inflexible methodologies of treating patients means that all patients get treated alike, and the ideal therapy for the patient may be overlooked.

Then again, this is the same doctor who believes only doctors are capable of determining what patients need breathing treatments and how often (usually Q1).

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