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, 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 some 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 something might speed things along, I explained why it wouldn’t. Never forgetting their manners, the parents expressed gratitude. I left them my cell phone number and urged them to phone if any problem developed. 

We parted on good terms, but I could sense their disappointment. No matter what the doctor said, everyone knows that sick children must rest. So they would wait.  

Worry

A worried mother phoned, asking me to see her two year-old who had a fever of 101.

I’d seen the child two days earlier. He had a 101 fever but was not particularly sick, and my exam was normal. I diagnosed a virus, handed over a bottle of Tylenol, and told the mother he might feel under the weather for two or three or four days.

Patients often call after a few days to tell me the illness hasn’t gone away. Sometimes they report a new symptom that gives me pause, but mostly nothing has changed. That was the case this time, so I reassured the mother. Another housecall wasn’t necessary.

People rarely argue with a doctor, so the mother did not disagree with my reassurance. But worry is contagious. No one is perfect, and there was a tiny chance that something terrible was brewing up.

I could have relieved my mind by sending them to a clinic. The doctor would find nothing and reassure the mother. If something terrible happened later, he was the last doctor she had seen, and I would be off the hook. But I didn’t do that, so I worried.

Two For the Price of Two

An insurance service informed me that two sick children awaited in Orange. It’s a rule that if one child is sick, there’s a small chance it’s serious; for two children, never. They almost always have a simple virus.

The major difficulty was the distance, nearly fifty miles, and the fact that my wife was preparing dinner. To my delight she offered to delay it and accompany me on the visit, something she rarely does. We had a pleasant hour’s drive to Orange where I cared for two children with a simple virus, and we ate dinner at the hotel.