Technology and the Therapist: A Therapist Speaks to Physicians

Abstract

To the Editor: The debate over the use of intermittent positive-pressure breathing (IPPB) therapy is spreading throughout medical literature and rightly so. At our institution alone, over 90,000 IPPB treatments will be given this year, while the physiologic rationale for this therapy is not entirely clear. However, I am afraid that the pertinent questions, those relating to the therapeutic value of IPPB for various pathologic processes, are being obscured by many of the people who could be resolving the issues. For example, an opinion frequently expressed is that IPPB is used because it is “big business” and “profitable.”1Petty TL A critical look at IPPB.Chest. 1974; 66: 1-3Crossref PubMed Scopus (9) Google Scholar I must ask the question, profitable to whom? Do hospital administrators or respiratory therapists order the treatments? No, they don't; physicians order them, and the physicians who request IPPB do not order it for financial reasons. Of course, there is a lot of money involved, just as there is in the use of whole blood, for example, but there is no nationwide conspiracy forcing people to submit to procedures for the sake of producing revenue. The second criticism of IPPB therapy that is often advanced centers around the idea that respiratory therapists and technicians are incompetent and rather dull-minded people who are concerned only with performing a mechanical function and not with quality patient care. One recent study produced pages of statistical data about controlling the quality of IPPB.2Yanda RL Quality control of inhalation therapy: The results of therapy, with and without control, and methods of developing such control, in a community hospital.Chest. 1974; 66: 61-66Crossref PubMed Scopus (4) Google Scholar It was a splendid example of begging the question that needs to be answered. The author told us that, without too much “threatening,” technicians could be taught to routinely measure parameters that have never been shown to be related to the therapeutic value of IPPB. With the specter of further government involvement in medicine, it is popular, albeit irresponsible, to create studies filled with catchwords and graphs that do not address the real problems. Again, we need to know if IPPB is good for anything. If so, why and for what types of patients? Those who are searching for someone to blame rather than looking for physiologic facts are engaging in a counterproductive pursuit, and I believe do so out of fear. I think that there are two specific fears that produce irrational approaches to the problem. First, respiratory therapists are afraid that their value as health professionals is identical to the value of IPPB as therapy. This, of course, is untrue because IPPB therapy, although frequently used, has ceased to be the foundation of modern respiratory care. Secondly, many physicians are worried because they are ordering IPPB frequently; and if it is shown to be largely useless, the question of why so many were ordered arises. The answer is disarmingly simple. Most patients who have received IPPB over the years have told their physicians that it has helped them to clear secretions or to breathe more easily. Certainly, physicians cannot be blamed for responding to this positive clinical input, because precise physiologic data have not yet been made available. The IPPB treatments have been ordered in a genuine attempt to use the technologic tools available. I sincerely hope that the fears, the emotionalism, and the irrelevant studies will not make it difficult for us to hear those who are attempting to determine the value of this popular mode of therapy. Hard facts can be obtained, as McConnell, Maloney, and Buckberg3McConnell DH Maloney JV Buckberg GD Postoperative intermittent positive-pressure breathing treatments.J Thorac Cardiovasc Surg. 1974; 68: 944-950PubMed Google Scholar have shown us in their recent study; and facts are what we need.