Sore throats and the learned professional

aka American ER Doc Gone Walkabout… 022 Let’s take a single complaint – “sore throat” – and look at a few of the ways that it can be handled. Let’s say that we’re satisfied with having a good outcome with no further intervention, say 90% of the time. And, another 9% of the time we get a second chance on a “bounceback” to get it right. To do this we might develop a very simple algorithm. Ask the patient if it hurts, and ask if he had a fever. Ask the patient to open his mouth – if he can open it, get a Rapid Antigen Test for strep. If he can’t open it, get a CT scan and call ENT to drain the abscess. The nice thing about this approach is that almost everybody gets better no matter what we do, so we’ll have a good outcome no matter what. But, Medical Doctors, like a shaman, needs a little theater, so the strep test and antibiotics come under the rubric “Medicine is show business for ugly people” (thanks, Greg Henry). Never mind that our ostensible reason to treat (prevent rheumatic fever) is, and has been for 50 years, a myth (thanks, David Newman). That, if we treat promptly with antibiotics, while shortening the duration of illness by a day, we will raise the one year recurrence rate from 5% to 35% (Pichichero, Ped Infect Dis J, 1987). And, that they’ll get better in a couple days anyway. The businesslike doctor knows that the patients love the theater of the swab, the test, and the a...
Source: Life in the Fast Lane - Category: Emergency Medicine Doctors Authors: Tags: American ER Doc Gone Walkabout Emergency Medicine Featured Health Pharyngitis professionalism rick abbott Sore Throat Source Type: blogs