The REAL reason some Doctors don’t prescribe Pulmonary Rehabilitation

The REAL reason some Doctors don’t prescribe Pulmonary Rehabilitation or Lung Cancer Rehabilitation (Part Two)

Thank you!

Hello everyone, I just want to take a moment to say “Thank you!” We have gotten overwhelming amounts of positive feedback via Email, and Social Media from Part One of this blog post as we discussed some of the reasons why some Doctors don’t prescribe Pulmonary Rehabilitation or Lung Cancer Rehabilitation.

When I wrote this blog post, I wondered if people would actually take time out of their busy schedules to read it. Wow, was I surprised at the results:

The number of page views on our blog increased from 5,431 to 15,998!
Blog Stats

I am sharing this information, not to brag (I’ll admit it made me very proud) but to acknowledge how great the need is for Pulmonary Patients to get their questions answered, offer them hope and for them to know they are not alone.

Also, someone said to me “Oh, you’re the guy that doesn’t like Doctors”

I will admit that I was a little surprised by this statement. This couldn’t be further than the truth. If you recall from Part One of this blog post I really emphasized:

“This article does not represent the majority of the excellent Physicians practicing today as well as the excellent Patients, just the ones that don’t get it. “

Personally, some of my best friends are Doctors and professionally 90% of all the referrals we get weekly are from wonderful Pulmonary, Cardiology and Internal Medicine Physicians. The message I am trying to convey is there is something huge missing from the treatment plan for Pulmonary and Lung Cancer Patients: Pulmonary Rehabilitation. Our goal is to simply help Patients by raising awareness.

Now, it’s time to discuss some solutions to help Patients get referred for Pulmonary Rehabilitation

 

“The only true wisdom is in knowing you know nothing.” Socrates
Let me start by saying it’s time to leave the egos at the door. We all have one common goal and that is to help Patients, period. Too many people (Doctors and Patients alike) are afraid to admit they don’t have all the answers. This is okay to admit, once we move past this little hurdle everyone will benefit. Please remember: Rule #1: You don’t know what you don’t know.  Never be afraid to say “That’s a great question! I don’t know, but I’m going to find out so we can both learn”.

Here are 4 key factors that will help appropriate Patients receive Pulmonary Rehabilitation:

1. Raise awareness of what Pulmonary Rehabilitation is and what it can do
2. Identify appropriate Pulmonary Rehabilitation candidates
3. Patients have to accept and admit that they need help
4. Doctors need to understand that Pulmonary Rehab is the missing puzzle piece in the treatment of mostly all pulmonary conditions.  Prescribing medications and oxygen is not enough!

1. Raise awareness of what Pulmonary Rehab is and how it is beneficial

What is Pulmonary Rehabilitation?

Pulmonary Rehabilitation can be defined in its simplest form as an exercise program specifically designed for pulmonary patients, allowing them to get stronger without the limitation of their shortness of breath.

How is Pulmonary Rehabilitation beneficial?

By reducing the Patient’s dyspnea (shortness of breath) we can then begin strengthening all the muscles in their body. Remember: weak muscles=increased dyspnea.
This increased strength and decreased dyspnea from Pulmonary Rehabilitation has been proven to help Patients by allowing them to:

  • Breathe better
  • Have less Shortness of breath (Dyspnea)
  • Improve their quality of life
  • Re-engage in social activities
  • Being able to travel and go on vacations
  • Have fewer hospitalizations
  • Have fewer Doctor sick visits
  • Save money by reducing medications, and co-pays
  • Lower or even eliminate oxygen
  • Getting their life back!

2. Identify appropriate Pulmonary Rehab candidates

 “I don’t have any Patients that are sick enough for Pulmonary Rehab”

Here is a true story that really shows how perception of candidate appropriateness needs to change.  I was recently speaking to a Primary Care Physician (PCP) about our Pulmonary Rehab Program.  Here’s how the conversation went:

Me: “How many patients do you have with shortness of breath?”
PCP: “Quite a lot”

Me: “How many Patients do you have that you prescribe Respiratory medications, like Advair®, Symbicort®, Spiriva® Breo® or nebulizers with Albuterol® or DuoNeb® ?”
PCP: “More and more every month”

Me: “How many of your Patients require supplemental oxygen”
PCP: “The number of those Patients are increasing too”

Me: “How many people do you refer to Pulmonary Rehab?”
PCP: “I really don’t have any Patients that are sick enough for Pulmonary Rehab”

 “I don’t have any Patients that are sick enough for Pulmonary Rehab”

This blew me away! I instantly realized that the perception that some Doctors have, is that their Patients actually need to be at a sick enough level to be an appropriate candidate for Pulmonary Rehab. This couldn’t be further from the truth. Early intervention is the key. Most of the time Patients themselves know something else needs to be done, they just don’t know what. That’s how this whole blog post began. The number one question we get every time we meet a new Pulmonary Rehab (PR) or Lung Cancer Rehab (LCR) patient is: Why didn’t my Doctor send me to you sooner?

Who is an appropriate candidate for Pulmonary Rehabilitation?

Believe it or not just because you have a Pulmonary diagnosis, wear oxygen and take respiratory medications, you are not automatically an appropriate candidate for Pulmonary Rehab. The first thing you need isPURPOSE followed by these other important aspects:

In order to be considered a strong candidate for Pulmonary Rehabilitation, you must be:
• Motivated with a strong sense of purpose
• Not in denial and willing to accept a life style change
• Willing to set aside 20-30 minutes per day for exercise
• Willing to commit to exercising 4-5 days per week (eventually, after a strong foundation has been established)

These Pulmonary conditions can benefit from Pulmonary Rehabilitation:

  • COPD
  • Lung Cancer
  • Emphysema
  • Pulmonary Fibrosis
  • Asthma
  • Bronchiectasis
  • Chronic Bronchitis
  • Asthmatic Bronchitis
  • Cystic Fibrosis
  • Alpha 1
  • Rheumatoid Arthritis
  • Collagen Vascular Disorders

 

Pulmonary Rehabilitation Candidate Quiz:

  • Are you often short of breath or more winded than you were last year?
  • Does shortness of breath make it difficult for you to do everyday tasks? (Walking 100 feet, climbing stairs, walking up hills, making the bed etc.)
  • Do you wear oxygen?
  • Are you already being treated for COPD, but still have shortness of breath?
  • Have you been diagnosed with Pulmonary Fibrosis?
  • Have you been diagnosed with Lung Cancer?
  • Do you use respiratory medications like: Advair®, Symbicort®, Spiriva® Breo® etc.?
  • Would you like to control your breathing instead of having it controlling you?
  • Are you motivated enough to exercise, but don’t know exactly how to start?
  • Are you not in denial and willing to accept a life style change?
  • Are you willing to set aside 20-30 minutes per day for exercise?
  • Are you willing to commit to exercising 4-5 days per week? (eventually, after a strong foundation has been established)
  • Do you want your life back?

If you answered YES to these questions, You may be a great candidate for Pulmonary Rehabilitation!

You can also click here to see how we can help you
Breathe better, Get stronger, Live longer!©

You can also download this quiz, print it and bring it to discuss with your Doctor.
Here is the link:

Adobe_PDF_icon
Pulmonary Rehab Candidate Quiz

 

3. Patients have to accept and admit that they need help

This is very important. Remember, your Doctor can’t treat what they are not aware of. It is time to have an honest dialogue with yourself regarding your real level of dyspnea (shortness of breath) and your compensations.

• Ask your family, friends & co-workers if they’ve noticed you experiencing shortness of breath or compensating due to shortness of breath

• How long have I been suffering and struggling with shortness of breath? Be honest, denial is not going to help

• When am I having shortness of breath?- Climbing stairs, Walking inclines, Walking too fast, Walking with others, Making the bed, Working with your arms above head

Accountability

Keep a journal of questions to bring to your Doctor visits.  This will keep your thoughts organized , get your questions answered and will also help your Doctor.

Stop scaring your self with the internet!  Be very selective regarding the information you are reading.  There is plenty of information and people out there to feed into your fears, avoid them at all costs! It is very important to establish a good relationship of mutual respect and trust with your Doctors and medical providers.

Do this at least once per year!

Be proactive! Ask your Doctor for a 6 minute walk test, an O2 check w/flight of stairs a Pulmonary Function Test (PFT) and thorough auscultation of your lungs at your next physical. Please be considerate and call ahead so they can schedule your appointment time properly.

Prove to your Doctor that you are self motivated and worthy of a referral to Pulmonary Rehab.

4. Doctors need to recognize that Pulmonary Rehabilitation is THE missing puzzle piece in the treatment of mostly all pulmonary conditions

 

Big question-LinkedIn

Doctors have prescribed respiratory medications, steroids and even oxygen for years. These things cannot and do not make up for lack of physical activity. Our bodies crave motion. Think about it, how many times have you gone for a walk even though you were tired you walked anyway and then felt so much better afterwards?  This is the foundation of Pulmonary Rehabilitation.

Summary

Pulmonary Rehab is the #1 treatment that actually helps Pulmonary patients.  Don’t just ask for it, demand it!

In summary, we have to be diligent in reminding Doctors that every time they prescribe respiratory medications and/or oxygen there should be a referral for Pulmonary Rehabilitation.  Not everyone one will be an appropriate candidate but this will certainly start the wheels in motion.

Finally, Patients need to prove to themselves and their Doctors that they care deeply about their health and that they are willing to invest whatever time and money required into having the best quality of life they can attain and deserve.

It all comes down to helping Pulmonary Patients breathe better allowing them to have the quality of life they deserve.

About the author:
David Junga, RRT is a Nationally Board Certified Registered Respiratory Therapist and Program Director at Pulmonary Rehabilitation Associates, LLC and PulmonaryRehab.com. David has been in private practice since 1999 and loves teaching patients how to overcome their shortness of breath.
http://pulmonaryrehab.com

David is also a Postural Alignment Specialist certified by the Egoscue University and Program Director at CtPainFree.com. His other passion is teaching people how to eliminate chronic pain through simple yet powerful corrective exercises.
http://ctpainfree.com

 

Courtesy of: http://pulmonaryrehab.com/blog/