Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Sunday, July 05, 2009
    Best Excuse Ever

    For the most part we docs are reluctant to prescribe antibiotics without seeing patients. The ever-present specter of drug resistance plays a large part here, not to mention the low (but possible) risk of side effects associated with antibiotic use such as allergic reactions, antibiotic-associated colitis and yeast infections. Sometimes, though, we don't have a choice. Such situations usually arise when we're on call and have no choice but to assess symptoms over the phone; after all, you can't send people to the emergency room for everything. In these cases you take a history over the phone and do the best you can.

    The most unusual case for antibiotics that I have ever heard was fairly recent, a patient calling on a Friday night with symptoms of a respiratory infection and a history of recurrent sinusitis. After sharing all this he added: "I'm going to swim with the beluga whales tomorrow for my birthday and I know I'm going to get worse after being in the water. And it's too late to cancel our reservation, we'll still have to pay for it."

    My mouth fell open. "You're going to what? With what?"

    "Swim. With belugas." He sounded entirely rational, but to me this made as much sense as saying "We're going to fly with pink elephants tomorrow." Apparently it's possible to make reservations at Sea World, or some such place, to swim with beluga whales.

    I gave him the antibiotics. Even if the guy were lying through his teeth I felt he deserved points for originality.

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