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September 2003 - While I was out!

There it was. Right on top of the mountain on my desk, waving like a flag. Why did I come back from my lunchtime constitutional, leaving the fresh air and sunshine behind? Oh the joys of gainful employment! "While you were out …", the note began. What a fascinating little word "out" is. Was I temporarily asleep, dismissed, Nigelled, chasing the sheep out of the back paddock or just "out to lunch"? My trusty Australian Concise Oxford dictionary provides more than a column's worth of alternative meanings to choose from! But I digress.

While I was wherever I was, doing whatever I did, someone was trying to contact me in an effort to provide a spirometry training session for GPs and their nurses. Of course, the request was suffixed with the usual "…being after-hours, we cannot expect people to stay more than 2 hours."

What to do? We as a Society are developing a position paper, in conjunction with TSANZ, that defines the core requirements of any training programme for people wishing to practice spirometry. There is nothing in the core components discussed at the last Board meeting that was not important, relevant or necessary. The Spirometry Subcommittee envisaged that this core programme would take 10-12 hours to deliver including time for assessment and certification of the participants. How could I hope to include all these essential components in 2 hours or less? It cannot be done!

What are the alternatives? I could decline the invitation. That would salve my conscience and uphold the Society's position. An alternative speaker would be found and the session delivered - perhaps something along the lines of "All you need to know about spirometry in 20 minutes". I was invited to give the session as a result of a lecture I gave at an Asthma Society education day. My message there had been the difference between monitoring and diagnosis and the reality had dawned, on at least some of the audience, that good spirometry was no simple matter but required specialist knowledge and experience.

There are two opposing pressures here. The first is the insistence on standards and quality. The other is the failure to recognise that good spirometry requires far more than having someone blow into a machine that can produce some numbers on a report along with a computer generated interpretation. The literature is replete with papers discussing the quality of GP spirometry and the difficulties of training and retraining of people doing spirometry. One wonders, however, about the advice sometimes offered in the literature. For instance consider the guidance offered to the American Association of Respiratory Care Conference in 2003, that you must "Yell, clap your hands, or click with your fingers near the patient's ear so as to startle the patient into delivering his or her fastest possible peak flow,…." .

The purist approach is to decline the invitation allowing me to stick to my principles. I will be able to point the finger and say, "They aren't doing spirometry properly." This may well make me feel righteous but is of little help to the patients running the risk of misdiagnosis and less than optimal management that can result from incorrectly performed spirometry.

Compression of the core information into two hours cannot do justice to the needs, albeit unrecognised, of the group who will attend the evening. It may, however, allow for the raising of the awareness that the practice of quality spirometry is not the simple task sales reps and manufacturers make it out to be. Only through raised awareness can we hope to win acceptance that training needs to be taken seriously.

I am sure this is a dilemma faced by many members. We all recognise the need but it strikes me there remains a gulf between desirable, nay essential, outcomes and practical outcomes at this point in time. My pragmatic way of figuring suggests that the most important goal at this time is to raise the bar on expectations. We are still a long way from the record, but if each jump is a little higher than the one before, then we will ultimately get there. Declining the invitation and allowing a 30-minute presentation to suffice will most certainly not raise the bar.

I really do not have an answer with which I am totally comfortable. On balance I believe that raising awareness of training needs is a necessary first step and, I would like to believe, that acceptance of the need for more comprehensive training will ultimately follow. Maybe I am just deluded.

If only I could locate that missing snag, I could have a barbie!

'til next month,


September, 2003




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