I am hoping we are past the peak of the influenza or ‘flu’ season this winter. It has been a tough season but as the snowdrops start to flower and the nights get lighter we can start to hope that it is passing us by.
One phrase I have heard a lot over the past few months is that patients or relatives have felt ‘fobbed off’ by being told they have a virus when attending the practice with cold or flu like symptoms. I have seen many patients that have been surprised when I’ve diagnosed them with flu, ‘oh is this what it feels like’, ‘I’ve never felt so bad’. Indeed, flu (caused by a virus) makes you feel just awful, fever, aches, fatigue and various other symptoms that just make you want to hide away in bed for a few days. It can take a few weeks to really 100% recover.
When I tell a patient it’s a virus, it’s not because that means I can’t be bothered diagnosing anything else, it’s because that is what is making them feel so unwell. There is nothing in my power to ‘cure’ a viral infection; your body will do a really good job of it with time and patience. Anti-viral medications like Tamiflu have been used in some at-risk groups this season but they can only reduce the impact of the virus rather than making you feel well quickly. For most patients, rest, plenty fluids and over the counter medicines like decongestants, paracetamol or ibuprofen help to make you feel less poorly.
The common cold, most sore throats and the majority of ear and sinus infections are caused by viruses not bacteria. You can feel very poorly with a viral illness so it does not mean we think you are not unwell. It just means we do not believe antibiotics will work because your symptoms are not likely to be caused by a bacterial infection. If we hedge our bets and give everyone antibiotics then we will just be giving our patients needless nasty side effects like vomiting or diarrhoea and even more troubling, potentially be increasing your future risk of resistance to antibiotics.
So what do I listen/look for when seeing a patient with what we call an ‘URTI’ or upper respiratory tract infection?
Ears: is the ear drum pink, red, bulging or perforated/burst, is the ear canal (tunnel of skin leading up to the drum) full of pus/discharge, is it red or sore? It is more likely to be a bacterial middle ear infection if the ear drum is about to or has burst, or if the infection is affecting both ear drums.
Chest: if a patient has a cough, I listen with my stethoscope and am listening for the air getting to all parts of the lungs. Wheeze sounds like a really high pitched whistle and is common in asthmatics or those with COPD (chronic obstructive pulmonary disease). A bacterial chest infection will sound like crackles in part of the chest. A ‘clear chest’ is generally reassuring.
Throat: are the glands in the neck enlarged or sore. Are the tonsils bigger than they should be, is there pus on them? We use something called Centor Criteria in a sore throat, it is very useful to help us determine if the patient is likely to have bacterial tonsillitis or not.
I also look at the observations, i.e. heart rate/pulse, how fast the patient is breathing and their temperature. In general terms, I don’t worry about the number of the temperature (young babies excluded) as it doesn’t matter if its 38.1 or 39.2 degrees C. It’s a fever, and that adds to my impression of what is going on with the patient.
On that note, if you are bringing a child to see us and you think they need paracetamol or ibuprofen because they are unsettled with a fever or pain, then please don’t withhold it because you want to prove the temperature to us. We will believe you, I promise.
Lastly, please allow yourself to recover. Both viral and bacterial infections take time to settle. Take a look at this really useful leaflet to see the expected recovery timeframes for common illnesses.