Do I really want that? Shared decision making and how this applies to allergy.

As #Christmas time approaches, it’s clear that Americans want choice. When I ask patients what they would like for Christmas, “I don’t know” is usually not their answer. Children’s eyes filled with sparkles at Santa’s coming, parents’ smiling at me and thankful I haven’t ruined their stories about Santa dominate our discussions about the holidays. Of course, I’ll always review medications and made sure that #asthma won’t ruin a perfectly good Christmas.

We choose many things in life, from what we eat to the clothes we wear every day to where we work. We choose our cars, our houses, our partners, and you’ll  object when someone else thinks they can tell you what to do. Except for #health care! A typical doctor visit usually goes like this….I need you to take your medication twice a day and I’ll see you back for follow-up in 3 months. What if my goal for treating my asthma is to take LESS medication to control symptoms? Or what if I don’t have time to implement everything I need for controlling my environment at home, such as vacuuming every other day for cat dander or keeping #pollen out of the house by closing and opening the windows 2-3 times per day? At the risk of being cheesy, wouldn’t it be nice to have a choice with your allergy care?

“Shared dialogue ” takes time on the part of both patients and your health care provider. I usually try and ask patients what their treatment goal for today’s visit is. For example, if your main concern about your hives is to stop the itching, it may not be productive for us to discuss how long the hives have been there, or what may be causing the hives, just fix the itching! The video below makes it apparent that you can have shared dialogue with asthma, urticaria, seasonal allergies, and even food allergy. I’ll give you more examples in a minute. (this video is < 5 minutes)

So what are some real life examples of shared dialogue with your doctor? I’ve included a clip below from a Tulsa pediatrician discussing treatment of spring time allergies recorded last year. This is a good example of 10 things you could do, but you only have time for five. Wouldn’t you want to discuss the most important aspects of your allergies first, and what’s most important for you? Don’t be afraid to be honest with your doctor, even though you have to change the direction of the conversation.

All tasks to do for allergy! (good job Dr. Whittrock and Channel 6)

Here’s my list for starting a shared dialogue with your allergist:

  1. Asthma is at the top of the list for disruptive illness that may send you to the emergency room or hospital. The cost of asthma in dollar bills, time off from work, and decreased quality of life is one of the highest of any medical condition. It is possible to prevent  unexpected asthma flares by using your controller medications EVERYDAY, instead of just when you start wheezing. Unfortunately, the cost of such inhalers sometimes forces you to choose between feeding your family and using your preventive inhaler. Talk with your doctor about this issue and many times we can together figure out a solution for affordable inhalers that at the same time can be used regularly and keep you out of the ER. 
  2. Better yet, how many of you take biological injections? Fasenra, Nucala, Dupixent just to name a few. Are we even bothered when steroids become first line treatment for asthma? We should be alarmed as the NHL Guidelines now suggest that one trip to the emergency room or unscheduled office visit means your asthma control could be improved. But some asthma patients take their medications as prescribed and still end up in the hospital or on too many steroid bursts (that number is > 1 per year)
  3.  When you first become aware of the cost of a biological that you only have to take once per month, you’ll fall out of your chair. (~$20,000 per injection). If you need a biological injection for your asthma, we have excellent resources to bring the cost down to an affordable level. Patients love an asthma medication they only have to take once every 2-4 weeks. Shared dialogue at it’s best.
  4. Urticaria or hives drives everyone crazy! Doctors can’t find the cause 60% of the time, and patients really become frustrated having to take medications everyday to control the rash and itching. A good question during your visit for hives is “what options do I have for better control?” Guidelines recommend using 4x the normal dose of antihistamines, but that puts most people to sleep for the afternoon! Xolair is a biological that has been around for 20 years to treat asthma, and was approved 5 years ago to treat hives. It’s been a life-saver for many patients, but may never have been discussed unless you’re bold enough to ask for options.
  5. Everyone thinks they have allergies and when properly diagnosed, allergy treatment can give you an A+ lifestyle. But how do you chose between the available treatments for hay fever?  Some of you don’t want the commitment of time & money for allergy shots–don’t worry, medications and getting rid of indoor allergens can make a world of difference for your sneezing. (just like Dr. #Whittrock said) Others want to avoid all medications possible for a lifestyle that allows you to get shots only once per month and have complete control of your allergy symptoms. Allergy shots (allergy immunotherapy) in this case are probably for you! What’s most important is your discussion with your doctor about what makes the most sense for your needs.

With Christmas right around the corner, please remember that you have a choice with many of the options for treating your allergies, asthma, and hives. Don’t forget to take advantage of your gift list for your health as well.

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