WHY A GOOD DOCTOR DOESN’T ALWAYS WRITE THE SCRIPT: Dr Elizabeth Oliver

I have two shortcuts in my medical software for this time of year.

Flu 1

“Has had joint aches, fever, vomiting, sore eyes and throat for three days. Now dry cough, severe fatigue. Feels like hit by bus. Usually fit and well. Looks terrible.”

I enter the specific features of their misery. Then comes my other shortcut.

Flu 2

“Advised regular paracetamol, ibuprofen. Rest, Netflix. Return in 72 hours if ongoing fever, develops chest pain, shortness of breath or heavily productive cough. Frequent hand washing. Avoid small babies, elderly and public transport. Advised recovery can take a month. Advised consider vaccination next year.”

Friends, the time is upon us. GPs are lining up the stethoscope, thermometer and tongue depressor on their desks. There will be at least eight people a day for the next four months who will roll in and say they have the flu, and they need something to “get it gone” by tomorrow, because they have canteen duty, or three kids, or they’re flying to Madrid. In the interest of my vocal cords, let’s clear up a few things.

  1. People will say that because they feel so awful, they must need antibacterials. But a virus and a bacteria are not opposite ends of the same spectrum of illness. They are totally different organisms. Antibiotics target the cell membrane of bacteria. Viruses do not have a cell membrane. They are not a cell. They are a piece of genetic code with some protein. I feel bad for you, son, but doctors aren’t holding out on you because they’re sadists. When you take antibiotics for influenza, the virus skips around between your dying hoards of healthy gut bacteria, laughing maniacally and breaking everything, like a toddler loose in a supermarket.
  2. Among the influenza, there will be at least five times as many people who get the “common cold.” A snotty nose and feeling a bit fuzzy is not “the flu.” Influenza (flu) is that thing you had that time – if you could have made your brain work, you would have worried you were dying. Some of you cried. Some of you called an ambulance. You remember it forever and recount the tale at family get-togethers. The common cold viruses cause some of the same symptoms as influenza, but are nowhere near as deadly, or unpleasant.
  3. Nothing will “get it gone.” If you see a doctor within the first few days of an influenza-like illness, you can invest in antiviral treatment (around $50), which may slightly lessen the severity. But to be honest, waiting out influenza is like dealing with the ATO, or being stuck in an elevator. Patient, calm, vigilant suffering is the order of the day.
  4. The vaccine is a gamble. It’s redeveloped seasonally, and last year the virus pulled a Jason Bourne and mutated after vaccine production had started. The vaccine was therefore misdirected, and we had twice the average number of cases. But for me, the odds are a no-brainer especially with everyone coughing in my face. Last year at least 3,000 Australians died of influenza, including healthy young adults and children. None died of the vaccine. I like it so much I have two – one in May and one in August, for the late comers.

If you’re sick and worried, see a doctor. “Just a virus” is about the stupidest phrase ever. (HIV is just a virus. Other strong performers include polio, Ebola, rabies, smallpox and herpes.) Influenza can be incredibly dangerous, as evidenced by the tragic deaths last season. Your doctor’s job is to assess how your body is handling the virus and whether you’re heading off road and need extra help in hospital. Other sneaky infections hide in the wave of influenza, and while they examine you, your GP is thinking about meningitis, measles, true bacterial lung infections and similar bad-ass rarities.

So if you’re sick, come on in. Just put on a mask in the waiting room. And understand that the doctor who writes you a script for antibiotics after 30 seconds is giving you what you think you need (as well as thrush and irritable bowel), therefore ensuring future business and saving themselves time. The doctor who elicits your particular cluster of symptoms, considers your medical history, examines you for signs of impending doom and writes you a medical certificate is doing the right thing by you and the people around you.

 Elizabeth Oliver is a practicing GP and RACGP fellow.

This article appeared in the Guardian in April 2018

She blogs at That Lady Doctor