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Coughs: the patient problem that just won’t shift

08 Jan 2018

It may not be the cough that carries you off. But it’s certainly the cough that’s doing my head in. And it’s not even my cough. It belongs to my patients, just about all of whom seem to have succumbed to the post-festivities viral upper respiratory tract infection (URTI)/can-I have-some-antibiotics/I-can’t-go-to-work-like-this-doctor syndrome.

All of which makes me both very, very busy and very, very bored. I appreciate it must be the same for you, although at least you have the consolation of shifting vatloads of income-generating cough mixture. And I do enjoy that little spiel you give about different linctuses for whether the cough’s dry or productive: I’ve always wanted to know, do you actually believe all that, or is it just placebo-justifying sales-patter? Do tell.

But I digress. What I really want to highlight is when to direct the coughing masses to us GPs. Or, rather, when not to. I appreciate you’re not the main culprit here – 111 is, being so risk averse that every cough appears to be a pneumonia until proved otherwise – but, when we’re trying to batten down the hatches, every little helps.

So. Your average coughing punter most emphatically does not need to see the GP. I don’t care that it’s gone on for two to three weeks (that’s par for the URTI course) and I care even less that the phlegm is a nasty colour (if you fancy a bit of evidence based medicine, here goes: spit colour has only a very tenuous link with bacterial infection and not enough to direct treatment. I know, a-maz-ing).

The exceptions are patients with COPD and asthma, though in that ideal world we don’t live in, they’d already have rescue packs and self-management plans, respectively. And patients who are breathless (as opposed to just bunged-up) and/or feverish (as opposed to a bit warm). Oh, and those who are genuinely ill, determined simply by observing that they look like death-warmed-up, which admittedly requires the focus to shift from till to customer.

These I will happily see and, who knows, I might even reward them with antibiotics. But please persuade the rest that I have nothing to offer other than a long wait and a dose of grumpiness.

And inevitably, even as I write, I can feel a burning in my throat developing into an irritating tickle which, tomorrow, will be the full-blown URTI: the legacy of being coughed on incessantly for the last few days. Fantastic. Anything you’d recommend?

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