Help me with telling a patient the dyspnea is just deconditioning..

[Mayford]

I have had 2 patients thus far who have gotten very upset because I + a bunch of others couldn't find anything to explain their dyspnea. And this was not for lack of compassion, interpersonal communication, time spent going over data, appropriate testing. One couldn't even give me an RER>0.9 on their CPET, has a BMI of 37 and put on 10kgs since the eval started 3 months ago (which they blame on not being able todo anything due to dyspnea).

I've told them that I realize it's frustrating to feel that way and not have the kind of explanation they're looking for, and that while I can continue to follow while they attempt some training/weight loss, we've done a thorough multidisciplinary work-up and there is nothing obviously wrong with their heart, lungs, muscles on advanced testing.

How do other people word these conversations?

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[tartesos]

TFTB should be an icd-10 code.
Too fat to breathe.


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[tartesos]

It's a frustrating conversation and needs to be had after some rapport is built during the work up and then lay it down as gently but firmly as possible.
I put in some anecdotes of my own experience running up steps to codes and being short of breath when I let myself go( you need to read the room and see if this would be fine).
It's a frustrating conversation, the younger the harder.


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[jdh71]

I have had 2 patients thus far who have gotten very upset because I + a bunch of others couldn't find anything to explain their dyspnea. And this was not for lack of compassion, interpersonal communication, time spent going over data, appropriate testing. One couldn't even give me an RER>0.9 on their CPET, has a BMI of 37 and put on 10kgs since the eval started 3 months ago (which they blame on not being able todo anything due to dyspnea).

I've told them that I realize it's frustrating to feel that way and not have the kind of explanation they're looking for, and that while I can continue to follow while they attempt some training/weight loss, we've done a thorough multidisciplinary work-up and there is nothing obviously wrong with their heart, lungs, muscles on advanced testing.

How do other people word these conversations?

I think the longer you practice the easier they will get. But I simply tell them I have no evidence of anything wrong by exam, imaging (CXR, CT, echo), and breathing tests. I usually give a trial of inhaled medications in these cases and I'll point to how the inhaled medications do not help. Then I'll reference the CPET which shows clear evidence of physical deconditioning and not a problem with either the heart or lungs. I will tell them I have nothing further to offer then and I will recommend weight loss and exercise as tolerated. Back to PCP.