My spouse (40 yo female) is newly diagnosed and we are already at our wits' end with local healthcare resources (living in Albuquerque, New Mexico, US). We are waitlisted with no end in sight for MDs/DOs, which would be our preference, given that my spouse has comorbidities.
She's been seeing a pulmonology nurse practitioner. I joined SO's appointment today to help with self-advocacy and ensure all of our questions were answered as the last appointment was not a good experience (waited 1:45 hours for about 5 minutes of visit wherein the provider assumed she already knew she had COPD then blew through a number of items before rushing my spouse out). I was pretty frustrated by the whole visit today. It felt rushed and we were talked over and condescended to then the medical assistant who was supposed to show us how to use a new inhaler and spirometer basically said “here, I don’t want to open it, but you probably know how to use it”).
So… we shall continue the search for a new provider. I am a bit stumped by one part that is actually pretty important in the near term and seeking advice.
We wanted to clarify her classification/staging as SO is being assessed for knee surgery. This will be a general anesthetic procedure and a significant one, so the difference between mild and moderate COPD is important for risk assessment and planning to her ortho doc and anesthesiologist.
At the first appointment, and again today, my wife was told she had moderate COPD because her pulmonary function test showed moderate obstruction (FEV1/FCV was under 70%, at 67%). I did some pretty deep research after the first visit, including the classifications (mostly to see what recommendations were for the patient, for treatment, and for prognosis given her young age). I asked to clarify the staging today since her FEV1 and FCV are both over 100% of predicted.
Prior to and following the diagnosis, the pulmonology provider has had none of the staging/grade specific tests (e.g., 6-minute walk for BODE or function questionnaire for the more extensive GOLD classification). So basically, the diagnostic tool is the PFT (no CT scan but she did get clear chest x-ray and echocardiogram).
The provider said they use GOLD and she is a GOLD 2 due to the FEV1/FCV. I asked about the FEV being part of GOLD stage determination (which from everything I see, classifies her as mild) and was brushed off and admonished-repeatedly-for researching and questioning her. ("We use the Gold standard. This is why you shouldn't be googling things. You find something on the internet and think it's true. We in the pulmonology world use best practices and guidelines from the American Thoracic Society." etc. etc.) I literally had the ATS guidance with me and the GOLD grading (old and with the newer A, B, C, D nuance) and she was so brusque, that after a few pushback questions I simply gave up as she was just getting more adamant and irritated. I am totally open for her to be considering other factors but she pulled up the results and walked through them, reiterating that the FEV1 and FCV were great but not part of staging. She also misread an overnight blood oxygenation study…. She did say that they will probably require another PFT within 30 days of surgery-so that’s good. But I worry SO may be assessed as too high risk due to a diagnosis of moderate COPD or have insurance refuse to clear her. Thoughts on how to approach?
Sidenote: My spouse was an advanced degree nurse and I do a fair amount of technical and health research for my career. I mention that to say that stuff like the GOLD pocket guide, differential diagnosis materials for physicians, pubmed journal articles, etc. are understandable.