Useless Medicine

Cora Mills had never been treated for asthma before, but when I saw her this winter with a sinus infection and a tight sounding cough, she was wheezing terribly. Her oxygen saturation was fine but her peak flow was in the low normal range. She refused the steroid pills I wanted her to take along with her antibiotic, so I offered her a prescription for an albuterol inhaler.

Cora had never used an inhaler before, so after I wrote her prescriptions, I left her room and got a demonstrator inhaler to show her the proper technique and let her practice a few times.

She had a little trouble coordinating her breathing and activation of the inhaler, so when there was a knock on the exam room door and Autumn, my nurse, announced that the Emergency Room was on the phone, I left Cora to practice on her own a few more times.

The call took longer than I expected, and by the time I got back to Cora’s exam room, she was already wearing her long wool coat, felt hat and scarf, ready to leave.

I quickly wrapped up the visit and told her to come back if her chest symptoms didn’t clear promptly.

Two months went by, and last week Cora came back in for her annual checkup.

“How’d you make out with your asthmatic bronchitis?” I asked.

“I had a terrible time clearing it up,” she quipped. That sample inhaler you gave me didn’t do a darn thing for my breathing!”

No wonder I couldn’t find my demonstrator inhaler the other day, I thought to myself.

“That was a practice device with no medication in it, I explained. I wrote a prescription for the real thing. Do you still have the placebo inhaler we used to practice with?” I asked.

“No, I was so upset with it that I threw it away!” She grinned and shrugged.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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