“He has pus on his tonsils,
so it’s probably strep,” said a guest, calling about her teenage son. I hear
this phrase regularly. It causes me some stress because I know that later I
might find myself delivering a why-antibiotics-won’t-help explanation to a
sullen audience.
One popular (i.e. wrong)
medical belief is that pus on tonsils is a sign of strep throat. In fact, this
is true only about ten percent of the time. Viral infections produce identical
exudates.
Arriving in the room, I
discovered that the boy had pus on his tonsils but also a fever, swollen, painful
glands in his neck, and no cough. Good scientific studies show that the
presence of these four signs: pus on tonsils, fever, swollen neck glands, and
NO cough raise the odds of strep to over fifty percent, so prescribing an
antibiotic is appropriate. I prescribed an antibiotic. The family made it clear
they were in the presence of a doctor who knew his business.
Isn’t science wonderful? It
is. But it’s wonderful in ways that are often not satisfying. More in my next
post.
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