FEVER AND FOLLOW UP
Be it a newborn or an ageing soul, fever just about terrifies anyone. It is one of the most common presentation in hospitals all around the world. So the following text is not a scientific literature on fever but more of a collection of experiences dealing with it.
A young man in his early 30s came to me with 1 day of fever and common cold. He had taken some Paracetamol for it but the fever would just come back once the effect of the medicine wore off. So after a brief history, I did a complete physical examination but did not find anything to come to a diagnosis. I attributed the fever to be due to his cold and counseled him to wait a few days and provided with some medications to relieve him of the cold. 2 days later, he visited me again. He still had the fever. So I asked him to get his blood tested. It was normal. His physical findings were still the same. Nothing in there to be worried. 3 days later, he was back. He still had the fever. And yet nothing on his examination. So I ordered some more tests. But they all came normal. I started him on antibiotics. 3 days later, he visited me again. This time, there was something different. I could just palpate his spleen. So I changed his antibiotics and ordered for one more test to make sure it was Enteric fever. Though the tests came negative, he started to get better with the new medication.
It was lucky for me as his doctor that he came back to me at all !! I have come to realize that patients rarely follow up. That poses a challenge for us to treat the patients who come to us. We are compelled to add an antibiotic to the prescription on the first visit with the fear that the patient may not come back if the fever does not subside in a day or two. Or the patient may go somewhere else for a second opinion where he will be prescribed with antibiotics for sure. Had the patient mentioned ealier not followed up with me, I would never have come to a diagnosis.
It is also possible that I order a long list of investigations to look for a cause for fever on the first visit itself. But would that really help me or the patient? Unless there are specific points that are pointing to a certain disease, ordering that long list would only be shooting in the dark and spending much money. It just would not be cost efficient. Not that it may not help. Sometimes it really does help.
To explain, there was once a young girl who visited the hospital for fever. Routinely, she was asked to do a blood count but the report surprised everyone. The white cells were abnormally high. After further investigations, she was diagnosed to have Acute Leukemia and was referred to Oncology Department for further treatment.
So how do we approach these two very different cases but with the same presentation- fever.
Sometimes we wait and watch, sometimes we do a few tests, and sometimes we end up doing many tests but find nothing. But the point I would like to make here is that one has to follow up with their doctor. Many diseases become apparent as time goes by. Fever is not so bad. In most cases, it is an elevation of your body temperature so that it becomes more efficient in fighting the invading organisms that want to harm your. So it is advisable to visit your doctor. But if it doesn’t go away in a snap, make sure to follow up. Because sometimes, it may be wise to just wait and watch. Sometimes, it may be wiser to do a few tests. Sometimes, you may need hospital admission. But one thing you will always need is a follow up.
If you have experiences you would like to share, please feel free to comment or email to doctor@medicinenepal.com
