Going Around
There are some characteristics that are universal among patients. All patients are afraid they have cancer. All patients to some extent do not believe they are mortal. All patients want their parking validated. These human qualities are easy to understand. What I don't understand is why all patients need to know that their illness is "going around".

Anytime I diagnose someone with an infectious disease, their first question isn't "Do I need antibiotics?" (that's frequently their second question) or "When will I start feeling better?" Their first question is invariably "Is it going around?" They desperately want to know if I've seen a lot of the same illness in my other patients recently. The reason for this question completely mystifies me. Initially I thought it was a simple case of misery loving company. A sick patient might be comforted knowing that there a lot of people in the same phlegmy febrile boat. But now, I think the reason is more complicated. I think patients believe that unless lots of other people have had the same thing recently, their diagnosis may be incorrect. They think that if they are part of a large herd with similar symptoms, then it's likely they have a cold, but if the last time I saw the same symptoms was a month ago then they must have something more serious -- lymphoma, or maybe lupus, because everyone knows that lymphoma and lupus don't "go around". But that's simply not how diseases are diagnosed. A runny nose and a cough in the absence of sinus tenderness, red eardrums, or abnormal lung sounds is a cold regardless of how many or how few other colds have been diagnosed in the same county recently. Lymphoma and lupus have entirely different symptoms -- symptoms which would be no less alarming if many patients had them in the same week.

Before learning of this unvarying patient need, I would frequently fall into a trap.

Me: Well, it looks like you have a cold. Some Sudafed might help keep your nose clear, and you can take Robitussin DM for the cough. I expect you'll be better in a few days.
Patient: Is this going around?

I'm a stickler when it comes to being honest with patients, so, not knowing any better, I walk right into the open manhole.

Me: I haven't seen any colds in the last few weeks, but the virus is around year-round. You probably got it from someone at work.

The patient's smile fades and is replaced by growing concern.

Patient: But no-one was sick at work. Maybe I need a second opinion...

[A second opinion for a cold? Are you trying to get me laughed out of the profession?]
Me: I'm sure you'll be better soon and if not, I'll be happy to send you to a specialist.

The patient leaves dissatisfied, wondering why I'm hiding from her the fact that she probably has pancreatic cancer. As soon as she gets home she gets the name of an oncologist from her sister-in-law.

After a few of these disasters I realized I'd have to modify my approach (though I still have no idea why). This is the only situation in which my answer to a patient is always the same, regardless of the facts.

Me: Well, it looks like you have a cold. Some Sudafed might help keep your nose clear, and you can take Robitussin DM for the cough. I expect you'll be better in a few days.
Patient: Is this going around?
Me: Yup.
Patient: [smiling broadly] Thanks a lot. I really appreciate you squeezing me in on such short notice.

My wife imagines a doctor working in a remote African village that is being decimated by Ebola. The doctor goes to the bedside of a very sick woman.

Doctor: Let’s see. Bleeding from every orifice, dangerously low blood pressure, very high fever... I’m pretty sure you have hemorrhagic fever, probably Ebola.
Patient: Is it going around?
Doctor: Oh, yes. The whole village has it. I’m catching the next flight out of here.
Patient: That’s good! I’m glad you stopped by.


- served up by Doctor Bean @ 10:23 PM