How many times have I suggested that you insist on a proper diagnosis before accepting any therapy? It should be obvious why this approach is sound – not only does it prevent you from taking drugs that you do not need, but it prevents you from getting sides effects that can be harmful. I have found another reason which is important to all of us, expense. I am not just talking about the expense you may experience paying for unnecessary drugs. I am talking about a much larger expense to the taxpaying country.
First, let me say that some diagnoses are not easy to make and require some analysis and the use of experience. In the case of COPD, however, there is a clear and accepted diagnostic technique to define the disease. A simple breathing test called a spirometry, which many of you who follow with our office are familiar with, not only provides the diagnosis but also allows us to follow the progression or stability of the disease. The test is simple and painless and is recommended by the National Quality Forum and many professional societies. A clinical diagnosis (one made without any corroborating tests) is unnecessary.
A recent study of over 14 thousand patients treated at one of three veteran’s medical centers in the Pacific Northwest revealed that only 62% of the patients treated for COPD had a breathing test to confirm the diagnosis. I would find this unacceptable anywhere, but especially in the VA system