Dismissive ER Doctors
There is nothing more frustrating than going to the emergency room (ER) for an asthma attack and being told that it’s “just anxiety”. If you have ever been to the ER with your asthma, I am sure you can relate to the sentiment. But how do you convince doctors to take you seriously when they insist on being dismissive? I am not sure I have all the answers, but these are the reasons I use to explain to doctors why it is not “just anxiety”.
The relationship between asthma and anxiety
John wrote a great article on this a few years ago. One of the problems with anxiety and asthma is that they have many of the same symptoms. These include a feeling of impending doom, trouble breathing, shortness of breath, racing heart, and sweating. Understandably, some physicians can confuse the two, but that is not an excuse for delaying treatment or dismissing symptoms. Asthma and anxiety cannot always be separated; they have a cyclical relationship. Anxiety can lead to asthma symptoms, and asthma symptoms can lead to anxiety. So, which came first? The chicken or the egg? Can it be both? 1,2,3,4,5
Not all asthma wheezes
When I arrive at urgent care with an asthma exacerbation, one of the first things a provider does is listen to my lungs. After which they say, “Well, your lungs sound perfectly clear!” Unfortunately, there is a grave misconception that everyone with asthma, or every asthma attack, comes with wheezing. And that is just not true. People who have asthma that only constricts the small airways, will not have audible wheezing. Another factor is nebulizer use, which can open up the airways, but does not always relieve the shortness of breath that comes with an asthma attack. Many people with asthma wheeze, but for those of us who do not, convincing a provider that we are having an asthma exacerbation can be a tremendous obstacle. 1
Oxygen saturation is just a number
After listening to my lungs, a provider will look at my pulse-ox reading, and proclaim, “your oxygen saturation is fine!”, thereby implying that it is impossible I am having an asthma attack. If only oxygen saturation was a valid indicator of illness. A few years ago, I had a sub-massive pulmonary embolism. I had a gigantic blood clot in my lungs that was preventing my body from being able to oxygenate its blood. I was severely ill. And you know what? My oxygen level was pristine! My medical records do not have an oxygen saturation recorded less than 97% when I had my blood clot. My body was having extreme difficulty oxygenating my blood, and yet, somehow, my oxygen saturation was normal. So, when doctors tell me that I am “fine” because my oxygen sats are fine, I do not put any stock in it.
How do I work with dismissive doctors?
There are a few things I have in place to help me deal with my asthma, especially when I have an asthma exacerbation. I have an asthma action plan that I use to help me decide when I need to seek care. My pulmonologist and I came up with this plan together. It is a plan of care that we both agree on and allows me to take control of my asthma and gives clear guidelines for when I need to seek treatment at the ER or urgent care. I also have a letter from my pulmonologist that I take with me to the emergency room. It has details about my asthma and how the emergency physicians can best treat and take care of me if I come in with an asthma attack. Finally, if I am able to get in touch with my pulmonologist, I have him call ahead to the ER and give them a heads up that I am on my way in. This often expedites treatment and provides validity to my seeking treatment.
Knowing these things, and explaining them to an emergency physician, does not necessarily help convince them, or lead to adequate treatment at all. Some doctors just cannot be convinced. But knowing how my body responds, and having a plan in place helps me get treatment when I need it.
Do you have any tips for working with dismissive doctors? Let us know in the comments!
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