Pulmonary Function testing is almost unique among medical tests in that it requires maximum effort and cooperation from the patient for quality results. The better you are able to communicate with a patient the more likely you are to be able to get good quality test results. This is one of the more interesting and the more difficult parts of being a technician.

Performing tests means being a cheerleader to some extent and over the years I’ve seen a number of different approaches. At one extreme, which thankfully I haven’t seen for a while, is what I call the “Nazi” approach which is mostly yelling and telling the patient as condescendingly as possible that they aren’t doing the test right and to do it again. At the other extreme is the “Flower Child” who is chatty, sympathetic, cheerful and can never, ever bring themselves to tell the patient they are doing anything wrong.

Neither extreme can consistently get good quality tests out of patients because neither makes an effort to explain what the tests are for, how they need to be performed and most importantly, to lead and correct the patient in a way that makes sense to the patient. The three most important rules in patient communication is first to explain everything, second to keep explaining and finally to explain some more. I’ve always found that every bit of time I spent explaining what, how and why always saved double that when it came to performing the tests.

Yes, cheerleading is important. Patients often don’t know what they are capable of without encouragement. But pulmonary function testing shouldn’t be a yelling contest. The only patients I ever got a sore throat from were the ones that were hard of hearing. Effective communication is the key to testing not volume. Keep it simple. Keep it clear. Tell the patient what they did right and be specific about what they need to improve. Saying “you can do better” doesn’t tell the patient what they are doing right or what they are doing wrong. Instead say “I’d like you to try to blow a bit longer” or “I think you can blow a bit faster”.

Being good at communication though, means that you need to really understand what you are trying to explain so you can tailor your instructions to each patient and I think this is a critical point of failure for many technicians. You need a good understanding of physiology, anatomy, physics, and pulmonary testing to be able to adapt your explanations to the needs of the patient on the fly but too many technicians, even good ones, learn the minimum to get by with and then stop trying to learn any more.

I’ve probably been spoiled since I have worked at teaching hospitals and always had access to medical journals and textbooks throughout my career. There is no excuse nowadays though, because a number of journals (Chest, American Journal of Respiratory and Critical Care Medicine, Thorax, Journal of Applied Physiology etc.) allow free on-line access to articles a year or so after their publication date and there is also PubMed and Google Scholar for searches.

I have to be honest and say that I’ve never been able to come up with a reliable way to motivate staff to keep learning. I’ve tried regular weekly and monthly classes, I’ve tried a journal club, I’ve tried handing out photocopies of articles and book chapters with a quiz, I’ve tried passing out problematic patient reports and asking “what’s wrong with this PFT?”. About the only conclusion I’ve come to is that you can’t force-feed the desire for learning. What you can do as a manager however, is to make sure your lab has an adequate procedure manual that includes tips for patient communication, make sure that all new staff sign off on the procedures and then to monitor your staff and make sure they are at least trying to communicate effectively.

I believe that technicians should also be able to talk to their patients about test results. Patients have the right to know their results and who better to discuss them than the technician that did the tests? When I first started doing pulmonary function testing however, I was never allowed to discuss results with patients. I was told that whenever asked my answer was always to be “the doctor will discuss the results with you later”.

Part of the reason for this was based in reality. The testing equipment I used at that time was entirely manual and when I was done with a set of tests all I had was several feet of kymograph paper with spirometer tracings and the gas analyzer numbers I’d written down on a worksheet. With a ruler and a calculator a full battery of tests would usually take me about 20 minutes to calculate and then hand write a report (with two layers of carbon paper in order to make copies).

The other reason though, was that medicine was still very paternalistic in the 1970’s and patients weren’t supposed to know or understand what their test results were about. The physicians I worked with at that time expected that all patient information and test results would always go through them and nobody else.

Fortunately, the physicians at the hospital I’ve worked at for the last twenty years encouraged me and the other pulmonary technicians to discuss test results with the patients. I have always appreciated this but also realize that if the PFT Lab staff were going to do this that we had a responsibility to be careful about what we said and how we said it.

When you discuss test results with a patient it is essential to keep any discussion to just the results. You can tell a patient that a reduced FEV1 means they can’t blow their air out as fast as they should but you can’t tell them that means they have asthma or emphysema even when a patient asks specifically asks if that is the case. You can tell a patient that their results are lower or higher than they were before but you don’t say that means they’re getting better or getting worse.

Interacting with patients has always been one of the fun parts of the job for me. It can also be difficult because you need to deal with people that aren’t feeling well or are scared, depressed, anxious, short of breath, or are just, well, being people. Remember, though, it’s not about you and you shouldn’t take it personally, and if you don’t like people, why are you doing this job anyway? I hope that everybody has the time and takes the time to talk with their patients and explain, explain, explain!

PFT Blog by Richard Johnston is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.