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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Elevated IgE
The Reason for the Reason for the Visit
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Malcolm J Sickels, Ann Arbor, MI Physician, Solo practice
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Interesting train-of-thought narative. While reading it, my train of thought caught the "elevated IgE" of the child and wondered if he'd been evaluated for allergies. A quick blood test can check for some of the most common inhaled allergies and if he shows and signs of eczema you can add on the top food igE allergies. Even if he's not up for a blood test, just a trial of allergy pillow covers can reveal dust mite allergies. ("One only costs about $10 and you can pick it up at most places that sell sheets. Wash all the sheets in hot water and put the cover on his main pillow before putting on the new sheets. See if it makes any difference: if not he's probably not allergic to dust mits, if it makes enough of a difference all you have to do is wash the sheets and the cover every other week in hot water, and if it helps some you can consider adding more allergy covers for other pillows and the mattress and using a HEPA filtered vacuum.") Of course, the best time to have done this is already past: before he was put on inhaled steroids and antihistamines. However, most people are up for a trial off medications in an attempt to be dependent on fewer meds. Yes, I know there was a study that purported to demonstrate that allergy pillow covers aren't effective, but if you actually read the article itself there was a pronounced improvement in symptoms when the patients first got the covers that faded with time. The patients weren't given any instructions about the pillow covers, so they probably just put them on and forgot about them. So, as time went on, the dust mites colonized the outside of the covers and their symptoms returned to baseline. Competing interests: None declared |
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Nancy J. Baker, Minneapolis, Minnesota USA Family Physician, University of Minnesota
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Brody begins this simple essay by describing his candid reaction to discovering that his last patient of the day has a headache. That’s enough to give most of us a headache- especially when we hope to complete our work “on time,” or in Brody’s situation, when he needs to finish promptly in order to meet his wife for dinner. Headache, backache, fatigue… these are just a few of the complex chief complaints we see in Family Medicine that often connote a far more complex, underlying psychosocial issue. Brody is pleased to find that his patient is five years of age. As the story’s narrator, he tells us what he is thinking, at the same time, he gently coaxes his young visitor to explain that he felt tired, and later experienced a transient headache which resolved spontaneously. Brody proceeds to demonstrate his extraordinary sensitivity and wisdom as a seasoned clinician. He knows that his young patient’s parents’ must have an agenda for him to address, before the visit ends. He seems to know their agenda will, in effect, “trump” his own, which is to simply diagnose and treat the lad as quickly as possible. In my experience, a patient comes to a physician with four underlying questions that must be explicitly addressed before any office visit concludes. He/she wants to know 1) “What do I have?” 2) “How did I get it?” 3) “What can I do for it?” and 4) “When will it be gone?” Even if on occasion we must humbly answer “I don’t know” to one, or more of these queries, patients usually leave the office satisfied, if not reassured, by our thoroughness and clinical vigilance. Brody’s patience eventually leads to a discovery- the reason for the reason for their visit. He succeeds in eliciting the parents’ underlying anxiety regarding their son’s recent diagnosis of asthma. Relatively quickly he allays their fear, providing comfort and education for all. With humility, Brody concludes his essay by asking, “Did I help out at all, really?” I suppose that depends on your point of view. Though we hope to have a positive influence on our patients, young and old, alike, they also have an influence on us. I suspect that both Brody and this young family enjoyed the encounter and left better equipped to face the inevitable challenges to health and well-being that face us all. Competing interests: None declared |
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