Calling Dr. Bauer …

As we start the new year, I would like to share some of the guidance I give my patients about when to call and what to do in case of an emergency. At the end of every clinic visit, I tell them to call me if they have any new breathing concerns.

I am contacted when there is more shortness of breath than usual or if they are experiencing chest discomfort. The first questions I ask are: “What does your sputum look like? Are you coughing up more amounts than normal? Is it dark colored or bloody? Do you have a temperature?” More and more, patients have portable oximeters at home to measure oxygen saturation. A marked reduction in oxygen levels can be concerning.

Answers to these questions help us decide if an antibiotic should be prescribed over the phone. Some of my “informed” patients will be given a prescription to be kept on hand at home in case they can’t get a hold of me or for an emergency.

I always encourage them to call first if at all possible. It’s too easy to take an antibiotic too often these days. Overuse of prescrip­ tions can result in resistant infections. I’m less inclined to recommend antibiotics if there is no concurrent fever. Many of my patients are on chronic steroid inhalers and/ or oral prednisone. I try to discuss a plan in clinic for increasing the dose of inhalers when breathing symptoms become worse.

A burst and taper of prednisone is often helpful, but again, I really like my patients to call before we mutually make this decision.

Most patients with chronic lung disease know when they can manage problems at home. I know most of my patients well enough that when I get the call, “Dr. Bauer, I really need to see you soon,” I make room for a clinic visit. On the other hand, when you can’t speak in full sentences, if chest pain is severe and saturations are dropping quickly, it’s time to come to the emergency room!