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throat

I occasionally work a shift at a clinic in a well-to-do neighborhood, that serves as a marked contrast to my usual beat. This is a community where the most fearsome boogeyman apparently is strep. It lurks under every bed, it hides around every corner, and is for some reason the greatest terror of this neighborhood’s residents.

This leads to another urgent care trope, No Sore Throat Shall Go Unswabbed. Ever vigilant lest a stray bacterium escape their notice, residents and especially parents will come in for throat swabs for even the most minor sore throat… or occasionally, if there is no sore throat at all but “it’s going around the school.” (It’s always going around every school in existence, btw.)

By far, the vast majority of sore throats are nothing but postnasal drip, such as from allergies or a cold. Phlegm and snot that you swallow really hurts the heck out of your throat after a while, but it is not something that responds to antibiotics. Strep throat, on the other hand, typically presents with some or all of 1) sore throat (duh), 2) swollen glands, 3) fever, 4) sandpapery rash, 5) bright red throat or tonsils, possibly with white spots.

It does NOT cause 1) congestion, 2) runny nose, 3) cough, so if you or your child has these symptoms, it most likely isn’t strep and you really should reconsider going in unless you see the bright red throat or tonsils in the mirror.

Anyway, because strep is more fearsome than Ebola for some people, we get a steady stream of people almost every day for any throat irritation whatsoever. Many will treat it as just another errand: They’ll come in with their groceries and get swabbed on their way home, just as if they are stopping to mail a package.

No Sore Throat Shall Go Unswabbed speaks to a deeper overutilization of our healthcare system that would have been seen as alien a generation ago. It extends to more things than just sore throats. For instance, I increasingly see people for routine stomach or gut viruses that people used to treat on their own. Some are Just Here for the Doctor’s Note, of course… but for many others, it’s because they do not want any illness go by without seeing a doctor first. The same goes for routine backaches or viral colds; the latter can be especially frustrating if the patient is already on antibiotics anyway for some other reason, but they want more. And every doctor has a story about the one who came in for a papercut.

WebMD has something to do with it. Plug in any symptom you can think of, and it will basically tell you that you’re probably dying of some horrible disease. People also are more vigilant of their health these days, which is a good thing when it comes to cancers or chronic conditions like diabetes, but less so for the common cold.

But these cases are a big part of what we do, and we do them well. Any doctor of any specialty should know that the case you decide to blow off will be the one where something is seriously wrong, after all. Urgent care clinics typically have far more patient volume than any other specialty, partly due to this trope, so we work hard and fast to ensure each and every patient gets the attention they deserve, no matter how minor the condition seemingly is.

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