Respiratory disease consultation

The core point of respiratory disease consultation is that you should clearly explain the four pieces of information in advance: "duration of onset, specific symptoms, past medical history, and recent medication." Don't just say "I have a cough/I have a sore throat." This can help you avoid unnecessary examinations, detours, and even misdiagnosis.

Last week, I was helping sort out cases in the respiratory department of a community hospital. I met a sophomore girl who rushed in with her mobile phone in hand. Her face turned red from suppressing her emotions and she said, "Doctor, do I have white lung? Let me see." This stunned Dr. Li who was attending the consultation.

After I calmed down and asked slowly, I found out that she had gone hiking with friends over the weekend to catch the wind. She had been coughing for three days after coming back. She had no fever and no yellow sputum. After watching the short video for half an hour, it looked more and more like white lungs. She even forgot to mention her history of allergic asthma. If she had just prescribed CT and anti-inflammatory drugs as she said, she might not be talking about the symptoms, but might induce allergic reactions.

In fact, many people have this misunderstanding. They make their own diagnosis first when entering the clinic, or they just say "I don't feel well" and let the doctor guess the rest. Just think about it, a doctor's consultation is like a police investigation. You hand over the original clues such as "when did you commit the crime, how did you behave when you committed the crime, have you ever had a similar situation before, and what medicine did you take blindly?" It is a hundred times more effective than your own guessing of "am I suffering from pneumonia" and "do I need an infusion?"

I have talked with respiratory doctors in different hospitals before, and now everyone has different opinions on "whether CT should be taken routinely for coughs": Most of the old doctors believe that as long as there are no high-risk signs such as persistent high fever, blood oxygen below 95%, coughing up blood, and being unable to lie flat due to breathlessness, cough caused by ordinary upper respiratory tract infection There is no need to pat the cough. It is self-healing. Patting is a waste of medical resources. However, young doctors will also consider the actual situation. If you have underlying diseases such as COPD or asthma, or if the cough has not improved at all for more than a week, or even gets worse, then you still have to pat it. Don't force it to become serious. Both statements are actually correct, they just target different groups of people.

Another controversial point is "should you take cough medicine when you cough?" Many people say that coughing is the body's self-protection, and it is expelling phlegm. Taking medicine to suppress it will slow down the recovery. This does make sense. If you only cough twice occasionally and it doesn't affect your eating and sleeping, you can drink more water to cope with it. It's a medicine that is three parts poison. But if you cough so much that you can’t even complete your sentence, you lay down at night and you cough all night long, and you have to go to work and school the next day, then it’s okay to take some mild antitussives like dextromethorphan. There’s really no need to fight with yourself. You’ll get better faster if you rest. Last time I coughed up my lungs from the flu, I took the antitussives for two days and slept well, which was faster than my colleagues who had to endure it.

Let me give you a negative example. Last month I saw an uncle in his fifties who had been coughing for almost two months. When asked what was going on, he waved his hand and said, "It's just a small cough. Just give me some cough syrup." Later I found out that he had been smoking for 30 years and had chronic bronchitis. He just thought that coughing was an old problem and should not be taken seriously, so he didn't tell the doctor anything, which almost delayed the matter.

Actually, there are really not that many complicated ways. Just go through these four pieces of information before entering the clinic. Don’t hide it or make blind guesses. Just tell the doctor the whole story. Oh, by the way, it’s best to wear a mask with better sealing when you go there. Don’t have a common cold. If you stay in the clinic for half an hour and get cross-infected with influenza A syncytial virus, that would be a real loss.