Category: Being a patient

When I was sick with a head cold, my head
full of pressure, my father would soak a washcloth
in hot water, then ball it up, ring it out. He would
open it above my head, then place it against
my face like a second skin, the light around me
disappearing entirely except through the spaces
between the stitching. I would inhale the steam
in that darkness, hearing his voice on the other side,
otherwise almost devoid of any other bodily sense
but the warmth and depth of his voice, as if
I had already died and was on the other side
of life waiting for the sickness to lift, but I wasn’t.
I was still on this earth, the washcloth going cold
on my face, my body still sick, and my father still
there when I opened my eyes, as he always was,
there to give me warmth before going cold again.
~William Fargason “Elegy with Steam”

A common clinic conversation this time of year:

I’ve been really miserable with a cold for three days, and as my COVID test is negative, I need that 5 day Z-pack antibiotic to get better faster.

It really can be miserable suffering from cold symptoms. Ninety eight percent of the time these symptoms are due to a viral infection and since your rapid RSV and influenza nasal swab tests are also negative today, your illness should resolve over the next few days without you needing a prescription medication.

But I can’t breathe and I can’t sleep.

You can use salt water rinses and a few days of decongestant nose spray to ease the congestion.

But my face feels like there is a blown up balloon inside.

Try applying a warm towel to your face – the heat will help improve circulation in your sinuses and ease your discomfort. When it cools off, warm it up again – basically rinse and repeat.

And I’m feverish and having sweats at night.

Your temp today is 99.2 so not a concern. You can use ibuprofen or acetominophen to help the feverish feeling.

But my snot is green.

That’s not unusual with viral upper respiratory infections and not necessarily an indicator of a bacterial infection.

And my teeth are starting to hurt and my ears are popping.

Let me know if that is not resolving over the next few days.

But I’m starting to cough.

Your lungs are clear today so it is likely from post nasal drainage irritating your upper airway. Best way to help that is to breathe steam to keep your bronchial tubes moist, push fluids and prop up with an extra pillow.

But sometimes I cough to the point of gagging. Isn’t whooping cough going around?

Your illness doesn’t fit the typical timeline for pertussis.  You can consider using an over the counter cough suppressant if needed.

But I always end up needing antibiotics. This is just like my regular sinus infection thing I get every year.

There’s plenty of evidence antibiotics can do more harm than good, eliminating healthy bacteria in your gut.  They really aren’t indicated at this point in your illness and could have nasty side effects.

But I always get better faster with antibiotics. Doctors always give me antibiotics.

Studies show that two weeks later there is no significant difference in symptoms between those treated with antibiotics and those who did self-care without them.

But I have a really hard week coming up and my whole family is sick and I won’t be able to rest.

This could be your body’s way of saying that you need to take the time you need to recover – is there someone who can help pick up the load your carry?

But I just waited an hour to see you.

I really am sorry about the wait; we’re seeing a lot of sick people with so much viral illness going around and needing to test to rule out COVID and influenza.

But I paid a $20 co-pay today for this visit.

We’re very appreciative of you paying so promptly on the day of service.

But I can go down the street to the urgent care clinic or do one of those telehealth doctor visits and for $210 they will write me an antibiotic prescription without making me feel guilty for asking.

I wouldn’t recommend taking unnecessary medication that can lead to bacterial resistance, side effects and allergic reactions. I truly believe you can be spared the expense, inconvenience and potential risk of taking something you don’t really need.

So that’s it?  Salt water rinses, warm towels on my face and just wait it out?  That’s all you can offer?

Let me know if your symptoms are unresolved or worsening over the next few days.

So you spent all that time in school just to tell people they don’t need medicine?

I believe I can help most people heal themselves with self-care at home. I try to educate my patients about when they do need medicine and then facilitate appropriate treatment. Also, I want to thank you for wearing your mask today to reduce the chance of transmitting your virus to those around you.

I’m going to go find a real doctor who will actually listen to me and give me what I need.

It certainly is a choice you can make. A real doctor vows to first do no harm while always listening to what you think, what your physical examination shows, then takes into account what evidence-based clinical data says is the best and safest course of action. I realize you want something other than what I’m offering you today. If you are feeling worse over the next few days or develop new symptoms, please let me know so we can reevaluate how best to treat you.

I’ll bet you’ll tell me next you want me to get one of those COVID vaccines too, won’t you?

Actually, I prefer you be feeling a bit better before you receive both the COVID and influenza vaccines. That would offer extra immunity protection for you through the next few months. Shall we schedule you for a time for your vaccination updates next week? Remember, I’m still here if you need to review your options again…