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Saturday, May 7, 2016

They tell me I'm short of breath

You know, among the respiratory therapy community you often hear grumbling about breathing treatments being ordered that aren't needed. Sometimes we're overburdened by them, although, for the most part, we're fine with it because it allows us to keep our jobs.

What becomes a problem is when patient's question the need for treatments. For instance, recently I walked into a patient's room, and I said, "How are you feeling? Are you short of breath?"

The patient said, "They think I am."

I said, "What do you mean?"

She said, "Well, I feel fine. But the doctors keep telling me I'm short of breath."

So I stayed with the patient long after her treatment was done and reviewed her chart with her. The patient truly was no longer short of breath, and various doctors noted this fact. However, one doctor noted that he suspected the patient was in heart failure and was very concerned about it. He offered a variety of treatments, including diuretics and a move to critical care. It all seemed logical to me. I reported my findings to the patient.

"Yeah," she said, "And they are going to move me."

"Why," I said.

"I don't know. The doctor scared the crap out of me. He asked me what I wanted if my heart stops"

I said, "Well, I can't fault him there. That's something they need to talk to you about. That's something you need to think about."

"Yeah, I guess you're right," she said. "But I don't see why I need to move to a different room when I feel fine."

I said, "I don't know the answer there. Do you want me to have the doctor or nurse come in and talk to you?"  I might have had theories, although I certainly didn't want to step on anyone's toes. I certainly didn't want to create a wedge between patient and doctor. I do not do that. Essentially, when I'm in a patient's room, I'm just a mediator.

"Sure," she said. So I did. I talked to the nurse, and she promptly came in to talk to the doctor.

We never did figure out why the doctor convinced her she was short of breath when that same doctor charted that the patient noted to feeling better. Some things in medicine elude even me.

Bottom line here is that the patient questioned the need for treatments, but she did not refuse it when I offered it. She knew she was not short of breath. She knew past treatments had no effect on her. However, she did get to enjoy the presence of her friendly neighborhood respiratory therapist. And, by the way, I gave Palbuterol (see #56)

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