It's a Virus...

Over the past 8.5 months, I've seen a very wide variety of patients in my clinic, in the ER, and as inpatients in the hospital. Most people I see have legitimate complaints....I would like to preface this by saying that I appreciate people who come to my clinic for any complaint - I don't care how trivial, how minor, or how silly some people may think it is, your quick visit to my clinic is one less person clogging up the ER and getting admitted for trivial, minor and silly things.

So the the lesson here is viruses...

1. Runny nose, headache, body aches, sore throat, cough, fatigue...etc, etc, etc.... If you are not coughing up bloody, green sputum, your fever is less than 102.6F (~39C), you don't have chest pain when breathing, and you can swallow, chances are you have a virus. No, I will not give you a z-pack. Like it or not, I will tell you to drink lots of fluids, get lots of rest, take lots of vitamin C, and let this resolve on it's own. Also, if you have a sore throat and a cough, and I see no pus in there, then it's not strep (sure there are exceptions, but if a strep test is negative and everything else points to NOT strep, please believe me.)

2. Nausea, vomiting, diarrhea, headache....etc, etc, etc.... If you are not having excessive vomiting or diarrhea (think less than 5 episodes per day), you can keep down some fluids, your mouth is moist, and you don't have a fever, chances are you have a virus. Now viral illnesses can leave you dehydrated (especially kids), so by all means, come see me and I can give you something for the nausea and diarrhea so that you can keep some of these fluids in your body. But no, I will not give you antibiotics. I will not order a stat endoscopy/colonoscopy. These studies aren't for acute viral illness, nor will they give me any more answers as to what you have. Like it or not, I will tell you to drink lots of fluids, get lots of rest, take an antiemetic/antidiarrheal, and let this resolve on it's own. 

I was taught once that viral infections will often show up with people complaining about all sorts of things - runny nose, sore throat, cough, headache, body aches, fatigue, dizziness, nausea, etc. And bacterial infections will likely have them coming in with only one or two complaints (usually the second one being fever) - sore throat, sinus pain, painful lump/abscess, pain with peeing. The exceptions could include (ie. there are others) pneumonias (which will have cough, chest pain, shortness of breath, often WITH cold symptons), or some bacterial GI bug (nausea, vomiting, diarrhea that is often bloody, severe abdominal pain, really high fevers, severe dehydration.) If your fever is high (>102.6F/39C), the symptoms are worsening rather than getting better after a couple of days, or if they last longer than the normal 10-14 days without letting up at all, then yes, you may have a bacterial infection. Again, these are all general rules, and by no means am I saying that any of this is concrete. That being said, I know a virus when I see one. 

The moral of the story really is this - if you come to me with complaints that you think is some raging bacterial infection, and I am 99.9% sure it's something viral, please do not insist that you need antibiotics. I usually will not give them to you...period. Fluids, rest, ibuprofen...that's what you'll get from me. No offense to those who 'do their research,' but your 20 minutes on wikipedia and webmd do not beat out my almost 10 years of training (and by no mean am I badmouthing wiki here....love it....I owe much of my degree to it really!) I don't tell you how to do your job, so please don't make demands of me and tell me how to do mine. You come to me for my expertise, so please respect it, and if you don't like it, then you can ask for a second opinion.  

Now please don't think I am insensitive to parents out there - I'm really not. No, I do not have kids, but that doesn't mean I can't understand how concerned you are about your sick child. I am concerned too, which is why I am not giving them medication that they do not need. It could make them sicker! Is that what you want? I respect that people worry, but don't assume that just cause I don't know you or your child that I don't care about you...I do. I have devoted my life to helping make people that I do not know better (you and your kids included), and your arguing with me and demanding things just frustrates me, and puts me in a bad mood all day. It doesn't make me change how I am going to treat you.