Tuesday, June 29, 2010

Deciding to go to the ER isn't an easy decision

I was having an email discussion recently with one of my asthma friends. She was telling me how she was reading my post, "Having asthma symptoms? Here's five tips to help you decide what to do," and started laughing when she read #3 on my list: go to the er if... you find yourself using your inhaler more than recommended.

I bet most asthmatics use their inhaler more often than recommended from time to time, and some of us more often than that. In fact, I think we asthmatics, along with some COPDers, and some cystic Fibrosisers, invented rescue inhaler overuse. And no, I'm not referring to abuse either. Yet, if you'd like, you can call us bronchodilatoraholics, which I wrote about here and here.

But, when you're referring to recommended, who'se recommendation are THEY talking about anyway. Are you talking about the recommendation of your doctor, or of the so called asthma experts or guidelines?

The asthma guidelines say if you use your rescue inhaler more often than 2-3 times in a two week period, your asthma is not in control and you should seek doctor consultation. Yet the guidelines also say that "control" may be different from one patient to the next. My doctor "recommends" I use my inhaler when I need it because I know my asthma better than anyone else -- which I do and always have (although I need it less often at the time being).

So, normal bronchodilator usage for me might not be normal for you. For example, I use my rescue inhaler 2-4 times in a day, while you might normally use yours 2-4 times in a two week period. So, by my definition, you should go to the ER if you are using it more than YOUR normal.
That was one of my better posts because I basically wrote that one to myself as well as other asthmatics. I don't find myself with bad asthma anymore, especially since I became a Gallant Asthmatic. Yet, I'm not really a Gallant Asthmatic -- I'm not perfect. Although what I am is the best asthmatic I can be. I oughta add that to the asthma types list.

It's funny how you could be an RT, a lawyer, an asthma expert, and whatever, and STILL have trouble making the decision to go to the ER. Yet being on the receiving end, working in an ER, I have never seen an asthmatic made fun of because he came in. Usually we herald asthmatics for coming in instead of waiting.

Although, my friend corrected me that the reason she hates going to the ER is because in her past she's been treated poorly. She said "made fun of" is a poor choice of words, that "whiners, or hysterics, or whatever" is more appropriate. She said many hospital workers treat everyone as though they are whiners and drug seekers and the like.

Although she did describe one vacation when she spent a night in a cabin near the small town I live in, and she had a good experience.

We do get our fair share of bad patients in the ER where I work. I would guesstimate that about 50% of patients don't need to be in an ER, and about 20% are whiners and hysterics and your drug seekers.

Although I couldn't imagine treating all patients as though they were. Yet sometimes it's hard to tell the normal folks from the whacky patients. Although if they're that bad in your ER, I guess I can understand why you wouldn't want to go there.

I'd like to think smaller hospitals would treat their patients better, especially considering we need to make money, and treating all patients like they are idiots wouldn't be a good way to do that. Larger hospitals have a steady flow of income that smaller hospitals don't have.

So why is it we have so much trouble deciding? I know: we're normal. Although by that philosophy, am I implying asthmatics who don't hesitate, who don't second guess themselves, are abnormal? Well, not really.


  1. Hmm... to realize that struggling with when to go to the ER is normal? I never would have thought of it that way till now, but come to think of it, I don't know of anyone with asthma who doesn't struggle with this issue. Some of my friends at college have begged me to go to the ER a few times (my roommate even dragged me there once), but there are definitely also those who make the decision even harder for me by telling me that I don't need to go (despite my action plan saying I should have been there several hours ago), and I should just drink more water and eat something.

    I've certainly felt like some doctors thought I didn't need to be in the ER, and I was a waste of their time, however, I've NEVER had an RT do that, even if the excaberation wasn't horribly bad. I guess this is why (and because of your RT cave blog) that I love RTs and think they have one of the coolest jobs.

  2. Before I was an RT, I remember feeling really bad and finally talking myself into going to the ER, and by the time I hit the air conditioning I felt fine. Yet I do find that most people, especially of the male variety, are hesitant to go to the ER. We never feel our episode is bad enough, although it probably is. I think it's the job of the medical professionals to make you feel at ease about your decision to come in, otherwise you'll second guess the next time something worse.