Discussion

In this survey almost a quarter of patients couldnot produce notification that they were taking steroid treatment. They must there-fore be considered to be at risk of receiving inadequate treatment in an emergency. Half of them claimed that a card had never been issued. It was impossible to verify this. With one exception, the remainder claimed that the cards were at home, although most of them were aware of the necessity to carry the card at all times. Some four subjects who had never received a card appeared to know why they should have one. Overall, only 65 patients could both show a card and explain why it should be carried. The discrepancy between recorded and actual doses in one-third of cases is of more academic than practical importance, since emergency" steroid cover" is an all-or-none phenomenon unrelated to daily dosage. Nevertheless, along with the failure of the patients to produce a card, for whatever reason, it points to a lack of close supervision of potentially hazardous treatment. During the survey cards were issued to all subjects who were unable to produce one; dosage was updated when necessary; and a full explanation given to each patient about the potential hazards of steroid treatment.