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This is why it is important to speak up

A cautionary tale about speaking up.

Today I had a pulmonary function test. The referral said specifically to test for before and after ventolin. But what nearly happened?

After the tech finished the before ventolin tests, she tells me: you can go now.

Me: You aren't going to do an ""after"" test?

Tech: No need. You are 100% on everything. Ventolin won't make a difference.

Me: But the doctor ordered both (me pointing to referral) - he did that because (a) I'm a singer (b) because I'm still symptomatic even when I'm supposedly 100

Tech: Oh. Sure we can do the ventolin

... gives me ventolin and redoes test ...

Tech: (surprised) there really is a difference.

Note: Everything didn't just increase a little - the various measures increased a lot - ranging from 9% to 127%. Apparently, ventolin does make a difference.

I almost didn't speak up because ""hey, she's the tech. She knows what she is doing"", but I'm glad I did .

So the moral of the story: don't just go with the flow and assume what the tech is doing is right even when it doesn't match what the doctor ordered. Speak up.

3 Replies

Thanks Beth for saying this!

I very nearly had the same and didn't quite have the confidence to speak up. In my case the consultant hadn't been as specific I don't think (in yours - exactly why does the tech feel the need to 're-interpret' what the doctor says, when they have specifically requested something?!)

The physiologist doing mine asked his colleague 'should I do reversibility when the FEV!/FVC ratio is 100%'? In the end he did it because he thought someone would probably tell him later that he shouldn't have missed it. And like you, it made a big difference - actually made the results make much more sense and also had the FVC go up well over predicted while FEV1 did not, changing the ratio to 71% and showing cons that like you, my best is better than predicted. So definitely something that was useful to the consultant in various ways (I think including that my technique improves with bronchodilator as well!)


exactly why does the tech feel the need to 're-interpret' what the doctor says, when they have specifically requested something?!)

I don't get it either.

Whatever the reason, I was lucky that she listened to me.

And I was lucky that the doctor was clear in his instructions. Sometimes I look at what the doctor gives me and only realize later that what I was given doesn't make sense. Fortunately, this wasn't one of those times. But it does make me realize that I need to think in advance and read things carefully before I leave a doctor's office.

I was also lucky that (a) I took the time to read the referral carefully so that I knew what it said (b) I have read enough to know the purpose of the pre/post test. (c) I knew enough about my own patterns to know it would make a difference. Without those factors, I doubt I would have been as insistent.

As it was, I think the tech only did a half-hearted after test. She only gave me 2 puffs and waited only 5 minutes. Maybe hadassah does things differently? From what I read, there are disagreements, but the consensus seems to be to use 4 puffs and wait 15 minutes.

For some reason, I didn't even ask her why only 2 puffs/5 minutes. Fortunately, no harm done because I did have a statistically significant response. But this also happened to be a good day. Had I been in the middle of a bad run, then i might well have needed the full four puffs and the full fifteen minutes before I responded to the ventolin. We might well have had a false negative.

I guess I exhausted my gumption for speaking up by that point?


Yes, I realised I have actually been more insistent than I remembered because of knowing more about my patterns.

A tech at this same hospital (not the person in this instance) who was actually quite rude and patronising on occasion (she actually told me off like a child once for taking inhalers 'like sweets') gave me only two puffs of Ventolin on a previous occasion and, what a surprise, it did nothing. I might have got somewhere sooner with it all if I'd known about that at the time and said something, but on later tests I always asked what they were going to give me and how much because I knew by then that 2 puffs wouldn't really be enough for me.

The time it was helpful, with the ratio changing, was 4 puffs and wait 15 mins; on another occasion (challenge testing plus reversibility) I was offered 4 puffs or a neb because I wasn't sure whether the puffs would help and the physiologist was happy to offer options (I did feel amazing lungwise after that, if rather twitchy and hyper). So I'd say (in my inexpert opinion) you were lucky not to have a false negative - but I know what you mean about once you've spoken up once you're more reluctant to do it again. Glad it did work out though and she at least listened a bit!


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