When to Call the Doctor: Fever, Nausea, Diarrhea, Colds, and Coughs

Medical Author: Benjamin C. Wedro, MD, FACEP, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

The art of medicine consists in amusing the patient while nature cures the disease. - Voltaire

Introduction

When it comes to expectations, there is a major communication chasm between physicians and patients. Patients want to be educated and reassured about their ailment, while physicians misinterpret that expectation, and work too hard to cure what ails the patient. Sometimes what a patient wants and needs may not be what they get. Much of  the "disconnect" in communication between the physician and patient involves their past experiences.

The world has become a much smaller place, with families spread far and wide. The concept of many family generations living near each other has been replaced by opportunities to live and work almost anywhere around the world. Travel has become more reliable, and communication across thousands of miles is instantaneous. The need to live near relatives is no longer a necessity. The downside to this mobility is the loss of generational experience. When a child is ill and has a cough, vomits, or develops a fever, too often there isn't a relative living close by to get a second opinion. Without that experience available to help with decision making, the parent or caregiver may call a nurse help-line, visit a health care practitioner to ask for advice, or search online for reliable information.

The physician may have a mistaken impression as to why the patient is seeking medical care. In the scheme of things, the most valuable part of a doctor's visit is the time spent listening to the patient, and offering guidance and education. Unfortunately, the physician may feel that the patient has to leave with a parting gift of some sort, and many times it is a prescription for a medication based on the presumption that the patient will be unsatisfied if they are not given sample medications or a prescription.

Education takes time, and a wise physician takes the time to listen to the patient, and answer questions that aren't even asked. Some situations are universal.

  • If a child's symptom is abdominal pain, the parent or caregiver wants to be reassured that the child does not have appendicitis.

  • If headache is the symptom, the answer the patient or caregiver wants to hear is that it is not serious such as  bleeding in the brain or a tumor.

  • Sometimes the visit is precipitated because of what's reported in the news. At the height of the H1N1 (swine) influenza epidemic in 2009/2010, news stories reported the serious complications of the infection, and many parents brought their children to a health care facility to be seen because they feared their child might die.

For many illnesses time is the ally, and watchful waiting is the key to diagnosis, treatment, and recovery. The following are common conditions that often resolve on their own without medical intervention.

Fever

Fever is a routine symptom in infants and children. It is a normal immune response to an infection to generate an elevated body temperature and make the body inhospitable. That doesn't mean that the fever should be ignored, but if the child is otherwise doing well, treating the fever with over-the-counter (OTC) medicines such as acetaminophen or ibuprofen may be all that is needed.

Fever in an adult is a different situation, because the patient is old enough to identify associated complaints and symptoms, and can provide a past medical history. Fever is a systemic response to inflammation. Patients with compromised immune systems and a fever are a completely different scenario. Those with immune system conditions or disease do not function as well as those who are not immunocompromised, and their body may not be able to fight off infection adequately. For example

  • people receiving chemotherapy for cancer,

  • those who take drugs to treat chronic inflammation such as rheumatoid arthritis or systemic lupus erythematosus,

  • individuals with HIV/AIDS may be so immunocompromised that their body may not be able to respond appropriately to an infection, and

  • older people may be very ill, but do not have a high fever (lower than 100 F [37 C]).

STAY INFORMED

Get the Latest health and medical information delivered direct to your inbox!