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Finding a Primary Care Physician Who Can Manage Asthma
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pinkpuffer posted:
I have been 3 years now diagnosed adult onset asthma. I have seen a pulmonary doctor as well as currently see an allergist/ashtma specialist. My problem is my primary care physician does not know how to manage asthma. I don't think he believes me when I say "I can't breathe!!". I am not a wheezer, I get tight and shut down. I do have an asthma management protocol I use designed by my allergist. However somethimes I just need to see the doctor. I feel when I self treat it does not get documented that I am having these attacks. My primary can not give any ashtma shots (like depromedrol) in his office. He puts me on too high of a prednisone does, doesn't prescribe Atrovent which I find helps when added to my alburterol nebs. Of course my allergist is fine with this, has a better weaning schedule for the prednisone. Again, I can't always get in to see the allergist. Am I expecting too much from a primary care physician?
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coughy16 responded:
If you are seeing an allergist/asthma specialist, why do you want your primary to manage your asthma? When my asthma flares up, I always go directly to my allergist, who treats my asthma, never my primary. The only reason I would go to my primary would be if I couldn't get in to see my allergist or one of the other partners. If you are having trouble getting in to see your allergist in an emergency situation, maybe you would want to check and see if you can find one who can see you same day when you are in trouble. If my allergist can't squeeze me in, she will give me instructions on the phone, or I will follow my action plan.
 
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bresky responded:
Hi pinkpuffer

I understand your concern. I can't always get into see my respirologist as it is a 3 hour drive one way especially when I am flared. However she wrote what I call a standing order or directions to my primary care doctor and the hospital I often end up with my asthma and most times the doctors follow her directions, or will call her for direction if they feel that the need further options. Is there anyway your allergist will do that for you? I also carry a copy of her orders incase I land up in a different emergency as I don't wheeze either just get tight until I stop breathing.
I have found my primary care physician pretty good at maintaining my asthma with guidelines from my specialist. However if I am finding I have flare up after flare up I will phone and see if I can get into see my specialist sooner then the next appointment I have.
I hope this helps
Bre
 
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pinkpuffer replied to bresky's response:
My allergist doesn't admit to hospital only sends you to ER. Most of the time when I do get admitted its after a couple of weeks on meds prednisone and finally I say I just can't breathe I need to go in and get the IV. Only my primary will direct admit.
 
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pinkpuffer replied to pinkpuffer's response:
And he doesn't follow anyone's plan. Puts me on way to high dose prednisone. My allergist has a better plan but I wasn't seeing him the last 3 hospital admissions. I just wish there was one doctor who could manage it all!
 
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asthmanp replied to pinkpuffer's response:
have you considered participating in a study at NIH? They have various studies that can help patients with mild, moderate and severe asthma patients.

http://patientrecruitment.nhlbi.nih.gov/CC/asthma-research.htm
 
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bresky replied to pinkpuffer's response:
Hey
yeah that is tough, I only have been admitted under my respirologist once when I was transferred because I stopped breathing, she is also an intensive care doctor so was able to care for me the three days, other wise I am admitted under my pirmary care doctor or who ever is working when I end up in emergency, but most are good at following the care plan. I am sorry he is not more understanding and willing to work together with you allergist could you find one that would work better with your allergist?
Bre
 
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sgbl88 responded:
HI pinkpuffer,

Most primary care providers don't know how to treat asthma. My PCP is really good for a PCP, but he now refuses to treat my lungs unless there is an infection. He will only treat the infection. It depends on what part of the country you are in as to how equipped PCPs are to treat allergies and asthma. Here, they see a lot of it and are pretty well trained on the basics.

The biggest problem I see with your PCP is that he isn't willing to work as a team member with the specialist for your best care. Here is the way I see the relationships working. It is very similar to a sports team with the head coach, and specialist coaches like defense, offense, pitching, batting, first base ...for baseball, quarterack, offensive line, kicking... for football, You and your PCP act as the coach and team manager making sure that all possibilities are covered and that there are no problems with drug interactions. The PCP should always defer to the opinion of the specialist when there are no conflicts just like a head coach defers to the opinion of his supporting specialty coaches for a sports team. The head coach/PCP looks at the big picture.

Unless you can talk with your PCP and convince him to be a part of the "team", you should probably be looking for a new head coach (PCP).

My two cents,

Take care and
God bless,
Sonya
Jeremiah 29:11 For I know the thoughts that I think toward you, saith the LORD, thoughts of peace, and not of evil, to give you an expected end... Ye shall seek me, and find [me]
 
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amcate replied to pinkpuffer's response:
I agree with Sonya. I don't understand why he doesn't follow anyone's plan. You may want to get a different PCP. Most PCPs don't know much about handling more severe asthma, but they should be able to see the big picture and coordinate all the team players.

As an example, my asthma requires a lot of corticosteroids to control. I was at a dead end with the allergist and insurance, so I went to the PCP to get his advice. He did not change the allergist's medicines or their plan, but he did say getting input from a pulmonologist to rule out other pulmonary disease was indicated and advised against extreme measures until further diagnostic work was completed. He advised ruling out obstructibve sleep apnea, altitude sickness, etc. Still, he has no problems following the allergist's plan in regards to medical management of the asthma itself.

I would not expect a PCP to be able to manage complex asthma, but I would expect them to cooperate with the team and be able to coordinate the team.


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