My Favorite Infections

Number one is urine infections in women, because I quickly make them go away. Handing over a packet of antibiotics, I assure someone who has been running to the bathroom every half hour that she’ll feel better by the next morning. In men, urine infections are usually prostate infections; these resolve slowly.

Eye infections (“pinkeye,” conjunctivitis) go away quickly after we prescribe antibiotic drops because most conjunctivitis goes away quickly whether or not antibiotics help (mostly they don’t). Everyone with a pink eye assumes they need eye drops, and doctors are happy to oblige, so we find these satisfying to treat.

Some intestinal infections respond to antibiotics but almost all occur in poor parts of the world. They’re rare in the US where vomiting and diarrhea is usually a “stomach virus” and short-lived.   

Amazingly, experts debate whether antibiotics help ear infections. Doctors in many nations don’t prescribe them, but Americans do. Patients give us credit when they get better. We like that.

A Delightful Bonus

The patient was a Brazilian two-year old who may or may not have had ear pain. Infants love everyone, and older toddlers are usually frightened enough to hold still, but from one to three years of age, children who don’t like doctors are uncontrollable. Taking a temperature in the armpit required the parents to hold her down. I dreaded the ear exam.

There was a knock on the door, and an elderly gentleman entered. This was the child’s grandfather, I learned as we shook hands, and he was a pediatrician. Immediately I held out my otoscope which he accepted with thanks. 

The entire family piled on; the child screamed and fought as the grandfather looked in her ears and forced open her mouth to examine her throat. He spoke little English but made it clear that nothing abnormal had turned up. He delivered an elaborate explanation to the family in Portuguese. I handed over a bottle of Tylenol, and everyone was happy.  

The Superiority of American Medicine

Patriots boast that American medicine is the best in the world. My view is more nuanced, but let me take their point of view. You’ll be amazed at the dumb things foreign doctors do!

They don’t give antibiotics for ear infections! 

If a child suffers a painful ear infection, the doctor prescribes an antibiotic. In many European countries, doctors give medicines for pain and fever but no antibiotic. If you’re wondering what happens to these poor European children, the answer is: they get better. Even in America, many experts believe that antibiotics don’t work for ear infections. It will take a lot more than expert opinion to persuade American doctors to avoid antibiotics in ear infections. American doctors love antibiotics as much as American patients.

They don’t care for hysterectomies!

Many women develop lumpy growths on the uterus called fibroids which may cause pain and irregular menstrual bleeding. A gynecologist can cure this by removing the uterus. It’s the second most common operation American women undergo (after caesarians; America leads the world in both).

The French have the odd idea the world would be a better place if there were more Frenchmen, so French doctors don’t sterilize women if they can avoid it. Mostly, they perform an operation that cuts off the fibroids but leaves the uterus intact. The surgery is more complicated and takes longer than a simple hysterectomy. American gynecologists could do the same, but they don’t, and they rarely discuss it with patients because they know American women aren’t interested.

They don’t try to cure every patient.

American doctors order more tests and prescribe more antibiotics, chemotherapy, and other powerful drugs than foreign doctors. They also perform far more surgery. These extras don’t necessarily cure. Sometimes they make patients sicker, but the important thing is that we’re doing something. American like aggressive doctors.

Foreign doctors spend a great deal of time making patients feel better – for example by ordering physical therapy (massage, exercise, heat, baths). American doctors prescribe physical therapy to speed recovery after surgery or injuries. European doctors prescribe it after childbirth and for migraines, irritable bowels, arthritis, fatigue, depression – dozens of problems.

European doctors actually send patients to health spas for baths, massage, etc., and health insurance pays for it! If you believe this is a waste of money, American doctors agree. Patients may feel better after a spa treatment, they explain, but it’s psychosomatic (in other words, if someone feels better -- but it’s only psychosomatic -- that’s not good).

It's Not an Ear Infection!

When I peered into the guest’s ear, the drum looked normal, so there was no middle-ear infection. When I pulled his earlobe, it hurt but not a great deal. In an external infection (swimmer’s ear), pulling is very painful.

Many adults with ear pain don’t have an infection (children are a different matter). I pressed a finger to his temple in front of the ear and asked him to open his mouth. That hurt badly. He had pain in the temperomandibular (jaw) joint.

The jaw joint is no different from the knee, ankle, or shoulder joint. You can injure it, or it can hurt for no obvious reason. This is common, but I can’t remember the last time someone complained of jaw pain. They tell me it’s an earache.

Flying with a middle-ear infection is a bad idea but no problem with jaw pain, so the diagnosis is good news, but guests are skeptical. Ear pain means an ear infection, and pain medicine lacks the cache of an antibiotic. Guests often make it clear that they’re not getting their money’s worth.