Thursday, May 14, 2009

Time, reflection and history

Time and the importance of stories have been on my mind lately. As students, we were told: 85% of your diagnosis comes from the history --the patient's account of his symptoms and experiences. Although I have no journal citation for this pearl, it reflects the centrality of the history to the practice of medicine. The telling and exploration of the patient's story not only gives information which may lead to a diagnosis (although this is certainly important), but serves as a source of connection, understanding and healing. (N.B. I owe a good deal of what I know about Thomas and Percy, several WWII battles and the Raffles Hotel to these histories.) A good story takes time: to tell; to listen; to respond; and to reflect upon its meaning. When all goes well, the patient's narration and our subsequent discussion tell me her experiences, priorities, situation, environment and goals. I am then able to facilitate her understanding of the possible explanations of her experiences (a differential diagnosis) and together we work out of plan to move forward towards those goals. For me, this is not the work of 15 minutes.

Tuesday, May 5, 2009

Happy World Asthma Day 2009!

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May 5, 2009 is World Asthma Day and this year's theme is "you can control your asthma".  May is asthma awareness month.  
Many folks with asthma put up with symptoms and decreased quality of life--including avoiding activities. All too many folks with asthma miss school/work or spend time in ERs or hospitals. About 4000-5000 people die from asthma every year. This is tragic, especially since most of this is preventable.
As an allergist and asthma specialist, I see quite a disconnect between my daily experiences and the grim statistics.  Most of the patients I see do pretty well once we figure out the right treatment approach. They lead active lives including--for some--extreme athletic events; we adjust our approach as needed and occasionally there are office visits for flaring symptoms. ER visits and hospital stays are things we discuss and (mostly) avoid.
I recently received an email with some interesting statistics excerpted from ACAAI Asthma Management--Better Outcomes at Lower Costs  regarding asthma specialists' care including:
45% decrease in "sick care" office visits:
77% reduction is amount of work/school missed;
77% reduction in asthma hospitalizations;
Reduction in costs (77% for ER costs, 95% for inpatient costs--is anyone in Washington listening...).
As I've said and written on a number of occasions, it IS possible to lead a full, healthy active life with asthma and I hope that this month more people living with asthma are empowered to do so.