Upper Respiratory Mystery

by Rob on September 10, 2010 · 25 comments

in Being a Doctor, Personal Musings

Credit

Colds make me uncomfortable.  Yes, I am uncomfortable when I have a cold, but that’s not what I am talking about.  I am uncomfortable when people come to the office for a cold.  It’s a very difficult situation for a doctor.

Are you kidding?  What could be easier than a person with a cold?

When a person comes to the office with a cold, it leads to the obvious question: why?  Why would someone come to the office for something that everyone knows is nothing serious.  Immediately in the visit I start searching for clues: are they looking for an antibiotic?  Are they looking for an excuse from work or school?  Are there other symptoms that the person is not telling?

It’s awkward.  When I first started in practice 15+ years ago, 99% of these visits were to get an antibiotic (“my mucous is green, so it’s an infection.”  - I thought everyone knew boogers are green), so I got used to giving my “no antibiotics for a virus” talk.  People were not receptive back then, so it was always a fight to get them to be satisfied being told to just wait and let nature take it’s course.  Fortunately, that’s gotten better with the unfortunate advent of multi-drug-resistant bacteria.  Still, there are a fair number patients that want an antibiotic because: a. Green = bad, b. Last time they got a cold, it ended up as a sinus infection and so they wanted to catch it early; c. They were around someone with “bronchitis.”  d.  They have a “weak immune system.”  I still get mad people at times because of antibiotic refusal, but most of the time I can avoid it.

So if they are not begging for bug-juice, why would they be here for a cold?   When the person comes in with 1-2 days of runny nose and sore throat, what are they looking for?  They often even say “I’ve got a cold,” and I am left asking to myself, “so why are you here then?”  It happens a lot.  I end up fishing for explanations.  I don’t want to confront them with, “so why the heck are you here for a condition your mom would’ve treated with soup?”  I think that would seem rude.

The common reasons for coming in for colds are:

  • They need a work/school excuse.
  • Their spouse/parent is bugging them to come in.
  • They want a narcotic cough medication.
  • They are hot and have heard our exam rooms are freezing.
  • They want to mystify their doctor.

Seriously, I am often left with the mystery of: “I think it’s just a virus and will go away on it’s own.”  To which the patient responds, “OK, thanks doc.”

Why does this matter to me?  It doesn’t much, after all, I do get paid for stating the obvious.  But I find myself wanting to get to the bottom of this mystery.  I suspect it has to do with UFO’s or the Bermuda Triangle.

Bigfoot came to my office last week with a runny nose.

Weird.

This material, written by me, is free to re-post and share under the Creative Commons agreement. In other words, use it all you want; just give me credit.
  • Toni

    I go because I have asthma, and when I start coughing stuff up I get worried. I don’t get antibiotics, but I get symptom treatment (usually cough syrup w/codeine) and if/when I start feeling worse I can just call for steroids or whatever else I need without dragging my now sicker body out of the house.

  • Pheski

    Depending on my best guess about the patient’s style and tolerance for irony or humor, I often respond to “I think I have a cold.” with one of these three: “Let’s make sure it’s just a cold, because then we know it will go away by itself and you won’t need to waste money on drugs that might cause side effects.” or “I hope not, because then I won’t be able to do much to help you, beyond perhaps some prescription cough syrup.” or “Medical science can’t do much about colds. What part of this do you need help with.?”

  • Rairy

    I went because two weeks of this hacking, driping, sneezing, aching, ickyness has reduced me to a whiney toddler who is hoping the doc has something magic to make it all better.

  • http://distractible.org/ Dr. Rob

    With asthma it’s a little easier to understand. Still, stating clearly at the start of the visit what it is you want to know is a great thing for the doc.

  • Clare

    Do you think that the new fear of the NEW types of bird flu and pig flu might be a reason??? I never go to the Doctor unless to refill my pain meds which I have barely been using anyway and now I have just found out my only Doctor I trust has just buggered off into retirement without any warning and I am stuck without a doctor of any kind!! I will definitely be sticking my foot out next time I see him coming!!! GRRRrrr …sorry completely off topic!!!
    What pleases me is hearing more and more that Doctors really are refusing to prescribe antibiotics unless absolutely necessary! Proud of you Dr.Rob. But I would and honestly think that People really should get kicked in the butt if they are going to the Doctors for common colds.Its very much like that in Germany.I think that has alot to do with the luxurious insurance system here and the at least until recently excellent working conditions in Germany.As soon as a German gets a pimple on his pump he’ll go to his doc get a sick note and take a week off work without fear of losing his job and safe in the knowledge that he is fully health insured.Although the job situation is changing here the more the Germans are using the job agencies and short termn contracts that are so often used in America and Britain.
    I think also it has to do with the need to be allowed to be sick….if you can go to a Doctor and the Doctor says to you go home get in bed and you be fine in three or four days then people feel better about saying ” I am sick” because the Doctor confirmed it!! Because there are those who know they feel sick but come from backgrounds like myself and never allowed themselves to be sick,we were never allowed a day off school unless the teacher sent us home or to the Doctor who then confirmed ” yes you are too sick to be at school,you are allowed to take a day off to recover” and once we were given the permission or confirmation to be sick only then could we “be sick”.
    Did I make any sense at all?

  • Clare

    I meant to say pimple on his bum and not on his pump!!Now I am REALLY embarrassed and unable to edit my comment!!! LOL

  • Lisa K.

    As someone who has visited the doctor for a cold my rational was that I was sick and the proper response to sickness is to visit the doctor. And if I was home from work more than a day or two, my colleagues always asked what the doctor has said. And, until recently, I was unwilling to self-medicate with OTC cold medicines unless the doctor had said it was ‘ok.’ (As a side note, my mother always took me to see the doctor when I had a cold and never treated me with chicken soup.)

  • http://distractible.org/ Dr. Rob

    I realize some folks were brought up this way. The purpose of this post was just to laugh about the fact that something so simple could drive docs like me crazy. I am always asking “what do they want from me?” and this situation makes that difficult to determine. It’s always good as a patient to say the reason for your visit. “I have a cold” doesn’t let the doctor know why you are there, as docs have no power over colds. It’s just funny to me that colds make me feel awkward so much.

  • http://distractible.org/ Dr. Rob

    It all made sense except for the pimple on the pump.

    Yes, I think people are wanting an excuse – both as a rationale and as a sheet of paper. Saying “I need an excuse from work” up front at least makes the doc not have to guess.

  • Bob F

    This is the “pill cure” generation thinking there may be a new pill that will let them get over it and on with life. I will use whatever has eased the cold symptoms in the past and forget about bothering the doctor until I don’t get better or have something serious develop because of the cold. Normally in 10 days the cold is almost over. Plus I don’t like going to the doctor when I need to during cold season because people do not cover their cough or sneeze without covering their mouth. We ought to require masks be worn like some countries to stop the spread of cold and flu germs.

  • Laurie Brown

    Some people just want reassurance that it *is* just a cold, and not whatever gawdawful disease is in the news that week. I suspect the ones that say “Thanks, doc” are those folks. There is a lot of Scary Disease News out there these days, and some people will immediately think the worst- my mother was one of those. She didn’t treat my colds with soup; she rushed me to the doctor -I suspect the fact that I contracted pneumonia at age 5 had something to do with that- thinking that every cold was another bout of pneumonia and every splinter required a tetanus shot. Even if no treatment was required, she was reassured that she didn’t have to worry- this time.

  • thompsonweston

    And I know you gave him an antihistamine, maybe a leukotiene inhibiter and maybe a decongestant!

  • BarabooMD

    I have gone to the MD for a “cold” 3 times in the last decade even though I am one too.
    1. Pertussis outbreak in nearby town, and afraid my terrible cough might be that-needed to be tested.
    2. Bad sore throat and tested for strep-was positive.
    3. Needed narcotic cough med to get to sleep-still have the nearly full bottle for the future.

    Each time I did tell them when scheduling what the issue was. I strongly encourage my patients and staff to stay away from the office when they are sick but many can’t afford to miss work.

  • Nightshade1972

    I worked retail for a decade. I spent the last 8.5 years of that time working in a grocery store, where I was around not only lots of people, but lots of raw/uncooked food all day long. I also worked for a manager who was a bureaucratic nitpicker of the first order. As a retail employee, I was paid on an hourly basis, which meant, as you pointed out, that if I didn’t go to work I didn’t get paid. So unless I was having a severe fever/chills, I literally couldn’t afford to miss work. I kept a large bottle of hand sanitizer at my cash register, and inbetween customers I would take the opportunity to blow my nose into a large paper towel, then squirt both hands liberally with sanitizer. Customers who frowned when they saw me blow my nose got a lot more pleasant when they saw me use the sanitizer. Many customers thanked me, then proceeded to ask me why I was even there if I was so sick. I explained to them that one of my managers liked to threaten people with writeups unless they actually produced a doctor’s note, so unless I was sick enough to provide one, I couldn’t miss work.

  • Peggikaye

    I hate the need for school excuse. This infuriates me. Benjamin gets migraines with colds, nearly every time. Try going to school and concentrating with a migraine and a cold. Not happening.
    My word that he is sick is not enough. We MUST have a doctor excuse. The clinic we go to refuses to give one without seeing the patient. It’s a catch 22 … a useless appt wasting my time and energy, exposing my already sick child to more.

    Since I *am* immunocompromised, I’m supposed to go in with every cold. I only go in when it stops me. I love being told “let nature take it’s course” the lack of need for antibiotics is a relief for me.

  • http://khebert.blogspot.com/ Kyla

    I think most people just want reassurance it isn’t something more than a cold (strep, flu, pneumonia). Once you say it is just a little virus, they can go on with life.

  • Anonymous

    I see plenty of C diff from antibiotics given for colds. Many of these patients don’t come to the office complaining of colds. Their chief complaint is, “I need an antibiotic”. I suspect that these folks tend to migrate toward accomodating physicians and away from those who are stingy with their script.

  • http://twitter.com/mst3kmoxie Moxie

    I think some people like to come in just to be given a reassurance that it IS “just a cold”. Not that they’re necessarily hypocondriacs, but but to some being told not to worry by their GP is much like a young child being reassured by their parent. “They” know better, after all.

  • http://lynettecares.blogspot.com/ Mslynette

    Dr. Rob, I would bet the farm that most of those people are saying . . “I think I have a cold” or something, not I have a cold. Folks today don’t know what a cold is. They don’t know the difference between a cold and the flu or allergies. Even if they are saying to you, I have a cold, they are doing it as a question not as a statement. It was the grandmothers who treated cold with soup and the mothers who said that was no good and ran us all to the doctor for everything. So, here is how you solve this problem (and others) you go out and get a copy of Barton Schmidt’s Your Child’s Health for every examining room you have. This book is organizing like none I have ever seen. It tells you exactly when to treat at home, when to CALL the doctor, when to GO to the doctor during OFFICE hours, and when to RUN to the EMERGENCY room. It even tells you what to do at home. For a cold, soup, steam, tylenol, etc. Stick a bookmark in the page for colds. Now if we could just solve the problem about school and work letting people who are spewing germs (colds or flu) stay at home and not insist they come in anyway!

  • Anonymous

    Heh. The only time I ever went to a doctor for a cold was when I needed an excuse for work, maybe once or twice in my life. I figure, I’ll get over it in a week if I treat it, and seven days if I don’t.

  • dar

    g’day Toni,
    -been there,done that, until an 86 yr old customer at the garage advised eliminating All Dairy
    -well,3 decades later,this ol’ bod hasn’t had an asthma or allergy attack,runny nose or flu
    [ check out Dr.McDougall's google video on dairy& Robert Cohen's notmilk.com]
    cheers

  • Toni

    My asthma is not allergy related, it was caused by a horrid battle I had several years ago with pneumonia. My lungs never recovered fully from it.

  • kg

    Exactly! And when I have a throat that hurts so bad, I want it to be strep or something so we CAN fix it!! If I ever see a doc for a cold, I usually know it is just a cold but I am so miserable with the hacking cough that I need something I can’t get at the store. Tessalon is great. And the general populous does not know the difference between Benadryl, Sudafed, dextromethorphan, and half the time Tylenol, so they may be after you to write down what they should get to fix their symptoms.

  • WarmSocks

    I thought of you today, and this post, when I went to see my doctor about a horrible cough. I remembered your line about stating clearly at the start of the visit what it is you want to know is a great thing for the doc. Thank you; it worked very well.

  • Owenstx6

    Its because we have become sheep. Dr. Nancy Sniiderman and the like, have scared us out of our minds into believing that our own health IS a mystery and that docs know more than we do. Its a cult, really. Scare tactics (you could die if you don’t see your physician), promise-holding elixirs ( not one SINGLE cure, only symptomatic Tx) and propaganda ( Nancy Sniderman’s spot on Today show, brought to you by Novartis). Looking for narc cough meds? Are you serious? A school excuse? Yea, because having them home is so fun? You are so far out of touch. Its because we are afraid of trusting ourselves. Or because we have to get back to work before we lose a job. Or if a kid stays home over 3 days, we have to prove they’re sick (because god knows, a mom couldn’t prove it). Stop you’re whining. Your kids will go to college whether or not you’re there on Thursday. you’re leaving for a lavish vacation soon enough. Ha! You want more medically trained patients? Careful, if they ALL find out you’re no more smarter then them, you’ll be paid teachers wages and forced to CARE.

Previous post:

Next post: