Hacking at 0300

Part of the drudgery of medicine is all the certification and paperwork, and the petty bureaucrats who need to constantly justify their existence by creating new rules. All the rules are well-intentioned, but taken together pave the road to hell—keeping us away from our patients and actually helping people. One such well-paved path is the American Board of Pediatrics which, over the past 20 years, turned board certification from "Take a test" to "Take a test at home every 7 years" to "Take a closed-book test in a secure environment because we can't trust you, every 7 years" to "Take a secured test every 7 years, keep your medical license (even losing it for not paying taxes means you lose your certification), do Board-approved CME, get patient-satisfaction surveys, and do Board-approved quality improvement projects, every 5 years." There's no reason to believe any of this makes me a better doctor but without it, what's the Board for? But enough griping, I may write about this more later.

One of the first things I tried to do when I started at the St. Lukes Pediatric Care Center this fall was improve our asthma management and follow up, so my Quality Improvement project will be the Board's Asthma Practice Improvement Module. It's no different from what I'm doing anyway, with the added fun of filling out data forms online for the Board to adjudicate.

Asthma Management

Asthma is a growing problem in the US, and the NIH has produced a huge (4 MB) report on managing it, with lots of its own jargon. Basically it's a chronic disease that comes in attacks, which can either be in control—only occasional symptoms—or not in control—frequent symptoms. Either way, attacks are treated with rescue medicines, usually an inhaler that relaxes the muscles in the lungs. If your asthma is in control without any other medicines, then you have intermittent asthma. If not, you have persistent asthma and need control medicines to take every day to prevent attacks. The report further divides persistent asthma into grades of severity, but judging severity is inconsistent and largely irrelevant: if your control medicines keep you in control, good; if not, do something more.