Respiratory disease consultation

Organize three types of key information in advance, including disease course changes, medication history, and special contacts/basic medical history, to avoid two common misunderstandings: "prescribing antibiotics with infusions at the beginning" and "deliberately concealing/exaggerating symptoms". This can increase the diagnostic accuracy by at least 40%, avoid unnecessary examinations and prescriptions, and save wasted money.

Last week when I was in the general clinic, I met a girl who had been coughing for 14 days. As soon as she walked in and sat down, her eyes were red and she said, "Doctor, I'm almost dying from coughing. Please give me some strong and effective cough medicine, preferably infusion." I asked her when it started, whether she had a cold at the beginning, and whether she had phlegm. She was all vague. She said "It seemed like she had a sore throat at the beginning" and then said "I can't remember clearly." I might just have inflammation." In the end, I was unable to order a chest CT and blood routine, and the results showed no signs of infection. After further questioning, she said that she often stayed up late recently to eat late night snacks, and her cough became worse every time she lay down after eating. It was an airway cough stimulated by reflux esophagitis. She had taken cephalosporins for ten days, which cost half a dime, and she wasted hundreds of yuan in examination fees.

Oh, by the way, don’t think this is an exception. At least half of the people who come to my clinic for consultation can’t tell the key points. A problem that can be diagnosed in three to five minutes can still be confused after half an hour of wandering around.

Let me first talk about the details of the disease process that are most easily ignored by everyone. Many people only say "I have a cough" or "I have a sore throat" when they come for consultation, and it takes them a long time to think about any more questions. In fact, you should take two minutes to think about it in advance: Are there any triggers for the onset of the disease in the first place? For example, there was a cold wind the day before, or you had a very spicy hot pot meal, or you just moved to a new home and were exposed to paint? On the first day, did I have a fever or a sore throat first? Is the cough just a burst of coughing when you get up in the morning, or does it get worse when you lie down at night? Is there phlegm, yellow, white or foamy? Have you ever had symptoms that got better for two or three days and then suddenly got worse?

There are also many colleagues here who hold different opinions. They feel that now that there are all kinds of inspection methods, everything is clear from drawing blood and taking X-rays, so there is no need to ask such detailed questions. But I have been working in the respiratory department for almost ten years, and I really feel that these details are the first step in identifying problems. Last time, a young man who was a sophomore in high school came and said that he had been coughing for almost a month and that no medicine was good. I asked one more question, "Does the cough get worse every time you run two laps in physical education class?" ”He just nodded, and finally found out that it was exercise-induced asthma, not an infection at all. He prescribed an inhaler, and it was cured without using up half the bottle, and he didn't even draw blood.

Another thing is what kind of medicine you have taken since you got sick. Don’t hide it for fear of being accused by the doctor of “taking medicine indiscriminately”. I have met too many patients who insisted, "I haven't taken any medicine." However, it was found that the white blood cell pressure in the blood test was very low. After further questioning, they admitted that they had secretly taken Archie for three days. Isn't this misleading in judgment? If you can’t remember the name of the medicine, take a photo of the medicine box in advance and save it on your phone. If you really don’t know anything, just say, “I got the cold medicine at the drugstore. After taking it for two days, my fever subsided but my cough got worse.”

Oh, by the way, if you have underlying diseases, tell them in advance. Don’t think, “Why do I come to see you and tell you that I have high blood pressure?” If you have chronic obstructive pulmonary disease, rhinitis, or a bad stomach, these medical histories will have a great impact on the medication. For example, for patients with glaucoma, we cannot prescribe cold medicines containing ephedrine, otherwise it will easily cause an increase in intraocular pressure. If you don’t tell us, we will not open our eyes. If something goes wrong, you will be the one to suffer. There has been a high incidence of mycoplasma and influenza recently. You can also mention whether you have been in contact with anyone who has a fever and cough recently, and whether anyone in your family has the same symptoms. These are all critical basis for judgment.

Let’s talk about the two pitfalls that everyone is most likely to step into. Many people clamor for antibiotics and infusions as soon as they come in. I know everyone wants to get better quickly, but for ordinary viral infections and mild mycoplasma, oral medicines are completely effective. Infusions are not only expensive, but may also cause allergies, phlebitis and other risks. Of course, we don’t want everyone to just refuse the infusion. If you have really developed pneumonia, or you are vomiting after eating and can’t swallow the medicine, you still have to lose. Don’t go to the other extreme and refuse to cooperate with any treatment.

The second pitfall is to deliberately hide the disease or exaggerate the symptoms. Some parents are afraid that the doctor will not pay attention to it. It is obvious that the child only coughs twice occasionally and insists on saying that he is "too breathless to sleep." As a result, we order a lot of tests and find out that nothing is wrong, wasting money and tormenting the child.； There are also people who are afraid of having a CT scan. They deliberately do not tell the doctor that the sputum they cough up is stained with blood, but wait till the end to find out it is tuberculosis. This delays treatment for half a year, which is really not a mistake.

Last week, an aunt in her 60s came to the clinic for consultation. She had a crumpled little book with a crooked note on her daily situation: "I started coughing on Monday, no phlegm, and taking cough syrup didn't help. After cleaning the dust on Wednesday, the cough got worse and I would wake up at night." I glanced twice and confirmed that it was an allergic cough. I prescribed two boxes of anti-allergic medicines, which cost only more than 50 yuan in total. I came here this week for a follow-up check and I am already feeling better.

To put it bluntly, consultation is not an exam. You don’t need to be fancy or professional, just explain the actual situation clearly. You save time, the doctor also saves time, and in the end you get the most accurate diagnosis, which is better than anything else.