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A 42 year old white male presented to the clinic with chief complaint of congestion.

He says he has been suffering from nasal congestion, sneezing, runny nose for roughly three days now. He also complains of lack of energy, loss of appetite, and feeling hot and sweaty the first night. He also developed a dry cough yesterday. No other issues reported such as coughing up anything, trouble breathing, throwing up, rash, recent travel, or other concerns.

His past medical history was significant for high blood pressure for which he took medication. His vitals were all within normal limits. The exam was unremarkable. After a query from the provider, his answer was the title of this entry: “I don’t know what it is!”

WHAT IS YOUR GUESS TO THE MOST LIKELY DIAGNOSIS?

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The common cold.

And the question I had asked to trigger his mystified respose: “So, you’re here for a cold, then?”

How could he be 42 and not know what a cold is?

I’ve highlighted a number of serious and unusual cases in this series, but I don’t want to give the impression that things like tuberculosis or pediatric panhypopituitaryism are routine cases at the urgent care. Our bread and butter consists of the basics: Strep throat, UTIs, skin abscesses, minor traumas and, above all, the common cold. I can state with some confidence that if nobody with a simple cold came to the clinic, we would be out of business within months.

This despite the fact that there is nothing a doctor can do about a cold and that these patients are wasting everyone’s time, including their own. They would be better off spending their time and copay money at CVS buying over the counter medicines, which is where I sent him anyway. It is really quite silly to not know what the common freaking cold is and needing a medical professional. Therefore, “I Don’t Know What It Is!” falls under the same Tropes of Medical Silliness as Just Here for the Doctor’s Note, Antibiotics are Magic!Prescriptions for Zyrtec, and close cousin Have You Tried Advil For Your Headache?.

Anyway, the term “common cold” refers to an upper respiratory infection caused by one of a large number of virii, including coronavirus, rhinovirus and adenovirus, among others. Common complications or sequelae include asthma flare-ups, ear infections, pinkeye, and bronchitis. All of these should indeed be seen by a healthcare provider. But the cold itself is untreatable, as the vast majority of viruses have no direct antiviral “antibiotics.” And even the antivirals we do have are much less effective than their antibacterial counterparts. Tamiflu attenuates the flu virus only slightly; Valtrex can control a herpes or shingles outbreak but cannot cure the underlying virus. None of the dozens of anti-HIV meds can actually eliminate the virus, and up until recently, anti-hepatitis C meds were all expensive, dangerous, and limited to just a select few patients (now they are just expensive, expensive, and expensive).

But that is neither here nor there since there are no antivirals for a cold. And how could there be when there are so many different types of cold virii?

I sometimes wonder how much money the cold costs the American medical system every year in unnecessary doctor visits. It can’t be inconsiderable.

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