You Don't Need a Better Medicine

“My doctor gave me amoxicillin a week ago, and my sinuses are still blocked. I need a stronger antibiotic,” said a guest.

If a medicine isn’t working the next step is never to find a better medicine but to discover why it isn’t working. Sometimes there’s a problem that medicine won’t help.

Sometimes the patient needs a better exam. Pain on urination usually means a urine infection, and I’ve seen several patients whose urine infection didn’t go away after a course of treatment. They didn’t have a urine infection but herpes. It was obvious when you looked, but the doctor hadn’t looked.

Sometimes the patient needs to wait. After rubbing cream on an insect bite, patients worry when it grows to an itchy patch several inches around. I explain that insect bites generally worsen for two days and then resolve over the following days.

Sometimes the next step is to stop taking medicine. Treating pinkeye with drops usually helps, but patients occasionally return to complain that they’re worse. That’s because the drop has begun to irritate the eye. A few days after stopping, they feel better.

My malpractice lawyer warns me to warn you to read this purely for your own amusement. Only in mathematics can a statement be 100 percent true.

So if a medicine isn’t working, don’t stay away from the doctor on the grounds that I said it was OK.

No Income Today

A lady at the Westin wanted a housecall for her cough and fever. This seemed reasonable until I learned that she was under treatment for multiple myeloma, a serious blood disease. It affects the immune system, so any sign of infection is a red flag.

I explained that she needed more than I could provide in a hotel room and gave directions to the nearest emergency room.

                                                 *          *          *

Two hours later I spoke to a guest at the Airport Holiday Inn who was experiencing stabbing chest pains. Chest pain is worrisome, but significant chest pain lingers. Fleeting pain in an otherwise healthy person is almost never a serious sign. I looked forward to the visit when, after my exam, I would deliver reassuring news. That anticipation disappeared when the guest mentioned that he had suffered several blood clots in his lung and was taking blood thinners. He added that these chest pains were different.

Different or not, it was a bad idea to assume that these were trivial. I sent him to a facility that could perform tests.

                                                *          *          *

A travel insurance agency asked me to see a hotel guest in Encinitas.

“That’s near San Diego,” I pointed out. “It’s a hundred miles.”

I’ve traveled that far in the past and charged accordingly, but I didn’t want to quote a fee and risk having it accepted because I wasn’t in a mood for the grueling drive. A local clinic would be cheaper, I informed the dispatcher. 

                                                *          *          *

“I’m a physician in the U.K., and my wife has conjunctivitis in both eyes. I went to the chemist for antibiotic drops, but apparently I have to see an American doctor.”

“It’s unusual to have bacterial conjunctivitis in both eyes,” I said. “If you’re certain, ask the pharmacist to phone, and I’ll approve the prescription.”

Later the pharmacist phoned. When it comes to their own illness or that of their family, doctors are no more accurate than laymen, but they have no interest in my opinion. 

The Yearning for Drops

“I’ve been using them for a week, and the eye is getting worse.”

Hearing this over the phone, I’m usually not concerned. While there’s always the possibility of severe disease, the odds are that the eyedrops themselves have begun to irritate the eye.

Sure enough, that was my diagnosis. If you see a doctor with an eye problem, he’ll prescribe drops whether or not you need them. Many types of “pinkeye” don’t require treatment, but doctors believe (correctly) that patients with eye problems take for granted that they need drops.

Most people will not argue with a doctor, but it was clear (in retrospect) that the guest didn’t like what he heard. I told him to stop the drops and that the eye would feel better in a few days.

He was thinking:  “I have pinkeye, but this doctor says I don’t need drops. Obviously that’s because he doesn’t know what drops I need. I have to find a smarter doctor.”

When I phoned the next day I learned that he had gone off to an ophthalmologist.

This happened a long time ago. Nowadays I tell guests to use a harmless over-the-counter drop until the eye feels better.