Did I Miss the Instructions? Navigating Appointments That Are Twisty

This time of year always brings a new crop of fellows and residents to my severe asthma clinic. It is an interesting time of year, as they are ripe with enthusiasm and trying to sharpen their skills. However, they are fresh and hoping to impress their professor/my specialist with their recommendations. In my experience, they can be challenged by complex asthma patients that have a lot of knowledge or are they become so nervous that they fumble.

At a recent asthma follow-up appointment, I had a lovely resident who was quite thorough, making sure all the usual processes were checked off. I had spirometry, ACQ -6 completed, a physical exam, and an overview of my history and recommendations.

This is the part of the appointment that went all sideways. There was incorrect information reflected in the previous visit note, by a previous fellow, which meant that there were incorrect assumptions made that impacted treatment decisions.

Navigating this twisty asthma appointment

A positive that I learned is that at least part of the learning for the Fellow is reviewing and discussing cases. The downside is that I spent the majority of my appointment untangling this previously documented error, and getting the team back on track with the current status of everything and next step recommendations.

It can be so frustrating when appointments take weird twists. Appointment time is so precious. I felt heard but I did not have an infinite amount of time to get updates, make inquiries, or have discussions, especially the consideration of new medications.

At this particular appointment, we made a change to a long-standing medication. I felt like it came out of the blue, however, I learned it was a recommendation through an analysis of my case. The way that this recommendation was delivered had a lot to be desired. It wasn’t clear to me “why” would we make the change.

In follow up I learned that it had to do with the particular way the particles are carried to the lungs for this new to me medication. My specialist had seen wonderful results in several patients and determined it would be a good fit.

I do wish that it had been more of a discussion with me in the room as an active participant than just a recommendation that was dropped. I hope this is something that they will keep in mind and further engage with their patients on these decisions in the future.

Making changes to a medication

The rationale and the benefits for changing medications did sound positive, however, I was nervous about a change from a beloved inhaler. I was already familiar with the quirks of my current inhaler and I was unsure if I want to adjust to something new. I had been recently challenged with some newer side from my biologic so hesitant to add more of the unknown to the mix.

I would be changing from a Dry Powder Inhaler (DPI) to a Metered Dose Inhaler (MDI). I know there are different preferences amongst the patient community but I am a fan of the DPI. I would prefer not to carry a valved holding chamber around with me, or when I am traveling. They take up a lot of bag real estate. I know a little bag room is very much a first-world problem in comparison to better breathing. It can affect adherence and inhaler performance if you forget to bring them with you. Hopefully, I will find more enthusiasm for this inhaler change, and see the added improvement.

Have you ever had a visit that you felt like you missed the instructions on how it was going to go? I would love to hear about your experiences and strategies of navigating those situations.