Assume makes an “’ass” out of “u” and “me”

By Christopher Kim

Imagine that, a couple of times this past month, you had some difficulty catching your breath after a routine, morning jog. You tell your doctor about it, and after some questions and tests to 

assess your lung function, you are diagnosed with exercise-induced asthma. Your primary care physician (PCP) prescribes you a standard, short-acting beta agonist (SABA) in the form of an albuterol inhaler, and now the saga begins!

You are asked to schedule a visit with your PCP to follow-up and discuss your treatment plan, and you schedule a visit for next month. In the meantime, your physician tells you to follow the instructions and use the inhaler as a prophylactic prior to vigorous exercise or PRN (pro re nata – use when necessary). In the mean time…

As Dennis Hopper’s character famously said in one of my favorite movies from the 90’s, “What do you do, Jack? What do you do?!” (Speed)

With over 18.4 million adults and 6.2 million children in the U.S. diagnosed with asthma, chances are you are close to someone with asthma and have seen someone use an inhaler in person or on TV. Looks easy enough. Stick the thing in your mouth, puff, and breathe in.  No problem, right?

The truth of the matter is, only 7% of all asthma patients use their inhalers correctly1. More than half of pediatric and adult asthma sufferers do not fully exhale before inhaling their medication, and other common use errors include not holding their breath after inhaling a dose or using an empty inhaler because the patient can still feel a “spray” even though the canister is empty.

In February of 2016, a study2 was conducted by a team at the University of North Carolina to quantify the extent to which children with asthma are overconfident that they are using their inhalers correctly, and their results were astounding. 75% of the children in the study were overconfident (i.e., they reported complete confidence in their ability to use their inhalers correctly) but still missed 1.5 steps on average.

With that in mind, it is clearly dangerous for a physician to ever assume that their patient will take the necessary steps to ensure that they are taking their prescribed medication appropriately, but what are we to do? There is an overwhelming burden by healthcare administrators to reduce the time spent with patients and increase revenue by stacking schedules with patients one after another. The answer must be that the patient and their safety comes first.

As patients, we assume that we know how to use something that seems so easy and common. I’ve seen inhalers used before. What’s the big deal? It doesn’t have to be perfect. I don’t need to read the  instructions. Why do I need to waste my time going to the doctor’s office to be trained?

As physicians (and I am one myself), we often assume that the patient will do their due diligence in taking the necessary steps to use their inhalers. An instruction manual is included in the box. They probably know someone who can show them how to use it. It’s not that hard to use anyway. They would call if they have any questions.

The dangerous and operative word here is assume. It has become clearer than ever that assuming anything in medicine (as a patient or as a physician) can lead to serious consequences down the road. So, now what?

Testing, testing, and more testing! Here at Core Human Factors, we provide medical device manufacturers and hospitals the opportunity to test a product with real people (patients and healthcare professionals alike) to truly see how well their device stands up through any and all real-life scenarios that you could imagine. Hospital administrators, are also always looking for newer and more advanced systems and devices to implement in their hospitals  to optimize the health care system and hospital workflows, but how do you know that a particular infusion pump, hospital bed, or surgical stapler would be a good fit within your current hospital protocols? By testing it.

From war zones to operating rooms, if your device was meant to be used in a certain environment, we can test it. Whether you are a physician, engineer, or patient, human factors testing can bring the benefit of understanding the ‘why’ in order to accurately solve the question of ‘how’.

1 Misuse of medical devices: a persistent problem in self-management of asthma and allergic disease. Annals of Allergy, Asthma, and Immunology. January 2015. http://www.annallergy.org/article/S1081-1206%2814%2900752-2/abstract

2 Alexander D, Geryk L, Arrindell C, DeWalt DA, Weaver MA, Sleath B, Carpenter DM. “Are Children With Asthma Overconfident That They Are Using Their Inhalers Correctly?” J Asthma. February 2016; 53(1): 107-112.