Sunday, July 6, 2014

Turning Bad News Into Good

A glum eleven year-old sat on the bed. His glum parents and two glum adolescents sat nearby. The eleven year-old had developed a sore throat on the family’s departure. It had worsened, casting a pall over their vacation. They hoped I would make it go away.

Doctors love making things go away, and this would happen if the child had strep, the only throat infection (diphtheria aside) that medical science can cure.

Parents assume that a child with pus-covered tonsils has strep, but many viruses do this. Researchers have determined that a doctor can diagnose strep by observing four signs.  (1) pus-covered tonsils, (2) swollen neck glands, (3) fever, and (4) absence of cough. Since it’s strictly a throat infection, other respiratory symptoms such as cough or congestion make strep unlikely.

This patient had zero out of four. His throat and neck glands were normal; he had no fever; he was coughing.

Working hard to turn this into good news, I explained that the child had an ordinary virus. He would feel under the weather for a few days before getting better. I handed over several over-the-counter remedies, assuring them that these would help. Staying in bed wasn’t necessary. They should try to enjoy themselves.

When the father politely asked if, perhaps, an antibiotic might speed things along, I explained why it wouldn’t. Never forgetting their manners, the parents expressed gratitude. I urged them to phone if any problem developed, adding that I would answer in person.

We parted on good terms, but I could sense their disappointment.  

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