Medical Students Return for Clinical Experience

The Charles F. Schmidt College of Medicine medical students who learn history taking, physical examinations and patient care skills have returned to the office for their second year of training. Danielle Chang Klein will be seeing patients with Dr. Reznick on Wednesday afternoons this year. Dr. Levine’s student, Tyler Anderson, will be seeing patients with him on Monday afternoons. If you prefer not being seen by a medical student then please let us know and we will make sure you are seen just by your physician. I understand that being seen by a student is not for everyone. I also understand that it presents a unique opportunity for our patient’s in a relaxed clinical setting to teach our future doctors’ how they wish to be treated as patients.

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Adult Sore Throats 2015 – 2016 Flu Season

Robert Centor, M.D., of the University of Alabama at Birmingham, performed the definitive study on adult sore throats showing that 10% or less of adult sore throats are caused by bacteria particularly Group A Streptococcus . He went on to prove that bacterial Strep throats were accompanied by a cough, large swollen and tender lymph nodes, a temperature greater than 100.4 and an exudate on your tonsils. The disease is primarily seen in children age 2-7 and those who care for them and play with them. In adults who did not meet the criteria of having a cough, swollen and enlarged lymph nodes, a temperature of 100.4 and a tonsillar exudate, a rapid streptococcus throat swab was accurate 100 % of the time. If the quick strep analysis is negative you do not have a strep throat and do not require an antibiotic. We had two patients this past fall who did not meet the criteria of Dr. Centor, did not have the physical findings consistent with a strep throat, had a negative quick strep throat swab but upon performing a traditional throat culture were found to be positive for Group a Beta Hemolytic Streptococcus requiring antibiotics. Why did the discrepancy occur? According to the manufacturer they had to recall a batch of diagnostic material that was ineffective. Both patients were placed on antibiotics soon after their clinical course did not follow the path of a viral infection and both did well.

Most adult sore throats and colds do not require antibiotics. We reserve them for patient with debilitating chronic illnesses especially advanced pulmonary, cardiac and neurologic disease patients. With influenza season on the horizon we will continue to assess patient’s clinically using history, exam, quick strep throat swabs and traditional microbiological throat cultures where appropriate. I will continue to prescribe antibiotics where necessary but must admit, last years’ experience opened my eyes to a more liberal approach with the prescribing of antibiotics for simple sore throats.