Despite the personalized attention I get in our pediatrician’s office and their general responsiveness to calls — both to their own nurse call line and during on-call hours — I find certain aspects of this 20th-century practice frustrating. The most important ongoing issue relates (not surprisingly) to the one chronic condition we have to manage: The intermittent asthma of my youngest son, 5-year-old Ryan.

Back in April, at the height of Washington’s spring allergy season, I wrote about my frustration in feeling unprepared to help Ryan in crisis. After another asthma flare-up two weeks ago when Ryan had a mild fever, I decided that I needed to take a more active caregiver role. It was time to become an “im-patient consumer.”

The first need to address was the idea I had back in April — empowering Ryan and his family to feel confident in using an inhaler and spacer when he needs albuterol (rescue medication) immediately.

Step 1: I ordered a Flip Video cam via Amazon.

Step 2: I told Ryan that we were going to the pediatric allergist’s office and I’d videotape the doctor showing Ryan how to use the inhaler. To which Ryan responded with high face lighting up, “Cool!”

Step 3: At the outset of the visit, I explained the issue to our doctor and I instructed him that I would videotape him demonstrating use of the inhaler and spacer to Ryan.

Step 4: I filmed two approximately 30-second video segments — first, facing the doctor and second, facing Ryan.

Step 5: When I got home, using FlipShare, I quickly emailed the videos to my wife and Ryan’s grandparents with copy to me (the people most likely to be present when Ryan needed help with his asthma).

Step 6: I sat down with Ryan to watch the videos. I don’t know about your 5-year-olds, but with mine, just about the only thing cooler than playing on Daddy’s computer is watching video of himself on Daddy’s computer.

Step 7: We’ll continue to watch and practice until he (and his parents) feel comfortable that he can use the inhaler well enough to get the medicine he needs to help him breathe more comfortably when he’s wheezing and coughing. Ryan may not yet be able to define “self-efficacy” but we’ll all know it when we see it.

Result: I have an empowered 5-year-old at home now.

Sometimes our work life and home life collide…or at least it would be good if they did…

The Center for Information Therapy (IxCenter) has just submitted a grant proposal to NIH — part of the stimulus bill funding for comparative effectiveness research included requests for “information prescriptions” evaluations — in collaboration with Ix evangelist Kate Burke (an emergency physician) and some very progressive physical therapy (PT) practices in Massachusetts. The basic premise — and any athlete that has done PT to rehabilitate an orthopedic injury knows — is that physical therapists do great work, but ongoing improvement in orthopedic function often comes from the home exercise that the patient does on his/her own. And, equally importantly, it can be really hard to recreate those exercises at home based on oral instructions received or even text or a single picture.

The main Ix intervention in the proposal involves using Flip Video information prescriptions. The physical therapist uses the simple Flip camera to record that patient doing the PT exercise in the clinic and emails the video to the patient that day. I have grown fond of saying about this project: If a picture is worth a thousand words, a video is worth 10,000.

So that brings me home…  We’ve been monitoring my 5-year-old son, Ryan’s, asthma. Last spring (exactly this week), the spring pollen season triggered a reasonably severe asthmatic reaction (see Ix Gets Personal (Again)). He has since had one other bad asthmatic event, and a few consultations and allergy testing with a pediatric allergist. We developed a game plan for trying to prevent another April flare-up.

In many ways, we think our pediatric practice is great, but there are some things that it does not do well. For example, there’s no written (not to mention electronic) asthma action plan, so my wife and I sometimes have slightly different expectations of next steps.

In this case, most importantly, neither of us is a skilled practitioner in the use of an asthma inhaler. As a four-year-old, Ryan used a nebulizer (a clunky device, but one which is fairly straightforward to use), but the allergist trained us once (more than two months ago) in use of the asthma inhaler with spacer. We have no information beyond the package insert. I honestly don’t have a good recollection of the exact steps involved and — when I asked my wife how she did it last week when I was out of town — she confessed to not being too sure herself. And, little Ryan — despite his many talents — isn’t quite ready to teach his parents what to do.

Ryan’s breathing was strained this evening, and we eventually returned to the nebulizer to deliver his albuterol (rescue medication), but it’s not a very good solution. All I could think about was how perfect it would be if my pediatric allergist (or the medical assistant in his office) could have videotaped when he walked us through it step by step a couple of months ago. If he had then sent us this video information prescription via email, I’d be empowered to help my son manage his asthma effectively and efficiently.

It seems so easy, yet so far away…