Sunday, May 18, 2014

Amazing Medical Maxims

What many laymen believe are serious signs are not – and vice versa.  Here are examples.

1. Local pain is worrisome; widespread pain is reassuring.

When a guest suffers abdominal pain, I ask to see exactly where it hurts. When he or she indicates the entire abdomen, I relax a little. The common stomach virus produces widespread pain. When the patient’s finger rests on a small area, I worry about conditions like gallstones, appendicitis, or diverticulitis whose pain is usually localized.

2. One allergy can be serious; many allergies: not so much.

An allergy is a specific immunological reaction that can be fatal, but most drug reactions are not allergies. If a medicine upsets your stomach or gives you a headache that’s usually what we call “drug intolerance.” If you’re willing, it’s OK to continue it, something we never do with an allergy. However, doctors use “allergy” indiscriminately, and laymen add their own diagnoses, so many patients confront us with a long list of forbidden drugs. The major consequence is not illness but expense. If you say you’re allergic to penicillin, for example, an alternative costs fifty times more.

3. Things don’t turn into other things.

Mostly this comes up with viral upper respiratory infection (cough, congestion, sore throat, fever).  Everyone knows that antibiotics are useless for viruses, but if a doctor diagnoses a virus, many patients believe they’ve wasted the trip. This is where the maxim comes into play.

“If I don’t get something it turns into… “bronchitis…strep…pneumonia…a bacterial infection….”  It doesn’t. In otherwise healthy people, illnesses don’t change into other illnesses, and experts persistently warn doctors that giving antibiotics to prevent complications is positively harmful. They wouldn’t keep warning us if we didn’t keep doing it.

“Why don’t you give me a Z-pac. I promise not to take it unless I don’t get better.”

“If you’re sick after three or four or five days, it’s still a virus.”

“What if my mucus turns green?”

“Still a virus.”

“But my doctor always gives me….”

Bull’s eye!  They best way to get a useless drug is to ask for it. Doctors love helping you. If you make it clear that he’s missed the boat, he may give you something to make you feel “helped.”

Warning!  I and my legal adviser inform you that these are not rules but impressions. Doctors keep them in mind along with their vast knowledge, wisdom, and judgment. I’m writing this for your amusement, not to help you decide if you need to see a doctor.  

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