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Friday, October 21, 2005

Reassuring a Blue and Breathless Patient

I've finished my first draft of the piece I was writing on the blue and breathless patient.

Part of the text covers dyspnoea - or "breathlessness" as it known to those of us without a medical degree, but with common sense.

Breathlessness may, the text notes, be caused by anxiety. It then goes on to explain how to manage breathlessness. Most of the suggestions seem sensible: position the patient in an upright position; give oxygen; give drugs. However, one suggestion concerns me:

- Reassurance (this may reduce anxiety)

No, no, no! As I learnt during therapy, reassurance does not help in the face of anxiety. It is only a short term solution, not a long term one.

Instead, I would suggest that any doctors treating a critically ill patient say: "Yes, you are critically ill. Yes, I know you're breathless! Yes, it could be that you're currently struggling for your last breaths! Maybe you will die, maybe you won't. Let's just wait and see, shall we?"

Now, this may not seem very kind but, as I think we all know, cruel to be kind is very much the rule with anxiety.

The patient will find that his or her anxiety initially climbs but, assuming the patient survives the racing pulse and highly unpleasant physical symptoms of anxiety - it will admittedly be a bit touch and go since he or she is, well, critically ill - he or she should find that the anxiety will reach a peak and then rapidly plummet.

And next time they find themselves blue and breathless and near death, they should find their anxiety isn't as great as the first time. And that's got to be a good thing!

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