Dr Troye explains: This is how doctors think …

Why the ‘safety net’ must come into play when diagnosing a complaint.

This is how doctors think …

Q. Leanne
I’ve had a bit of a cold and when I blow my nose, there’s blood in the tissue. Is that cause for concern? And my hearing is worse than normal. I don’t really want to go to the GP just for that. There are too many sick people there!

A. Your symptoms sound typical for a cold (or upper respiratory tract infection, URTI, to be technical). Most likely, the symptoms will resolve with time and rest. However, your question allows me to wax lyrical about a few crucial points.

The world of medicine is fascinating in that simple symptoms can be both nothing, and very serious. That is why when you Google your symptoms, it might say you have cancer.

The problem is that when people bring their symptoms to their doctors and the doctor tells them they are fine, there is a sense of dismissal or a feeling of wasted time. That is because much of the hidden value of a doctor is in recognising that the symptoms are not alarming.

This is how doctors think …

“Epistaxis (nosebleed) is a common symptom. It is most likely due to the dry air and the URTI, but it could be a marker of something dire. Nearly 100 per cent of the time it is nothing, but I cannot miss the cancer.

Are there any other signs or symptoms that make me think it is out of the ordinary? No. Good.

What can I do so that I do not miss the rare presentation of the serious illness?

I will put a safety net up.”

Now this is what doctors would say …

“You have a cold, and it is nothing to worry about. These symptoms are very common and will get better. However, if the nosebleed is still a problem in two weeks, come back and see me (the safety net).”

Then you leave thinking that you wasted your GP’s time or, even worse, your time. That is not the case. GPs are highly trained to pick up the serious stuff, and you did not have it. But because it is hard to see the negative, the value in the consult is missed.

Back to your question. The marker as to whether you should see your doctor is – you are concerned. There are so many barriers to visiting a GP – finding the time, getting an appointment, getting to the GP – that when your concern overcomes those barriers, you should go. And when you do go and are told it is nothing to worry about, see that as a good outcome rather than a mistaken decision.

By the time you read this answer, your symptoms should have resolved. If not, then please go and see your GP. (This is me safety-netting you.) It will still most likely be nothing, but you really should get it checked out.

Wishing you all a cold-free and healthy spring.

Dr Troye is happy to answer your questions. Simply send an email to: newsletters@yourlifechoices.com.au

Dr Troye Wallett is a GP. He is a co-founder and part-owner of GenWise, an ethics-based, purpose-driven mobile general practice which supports health professionals working in aged care.

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    COMMENTS

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    Grateful
    11th Sep 2018
    11:32am
    I had a nose bleed and reduced hearing and went to GPs on three occasions with the same diagnosis of a sinus infection and was prescribed antibiotics on each occasion. The problem wouldn't go away and the last doctor I saw sent off a mucus sample from my nose for analysis and it came back with no infection detected.
    He sent me for a CT scan which revealed a possible tumour and when I was referred to an ENT specialist who put me in hospital and took a biopsy, it came back as a nasopharyngeal carcinoma.
    Lesson, blood from anywhere is not "normal" and if it persists don't delay and go and see your GP.
    Bushbaby
    11th Sep 2018
    1:38pm
    I had several bad nosebleeds over a short period of time. It was diagnosed as an infection so when it happened again a few years later I thought maybe the same thing had happened. I was hospitalised with plugs in place to stop the bleeding and intravenous antibiotics to combat any possible infection, but the doctors couldn't see any obvious cause. A subsequent visit to an ENT specialist revealed a faulty artery at the back of the nose. Treatment? Get to the ED as soon as possible if/when it happens again because if not controlled quickly it may be fatal. The moral of the story? Always follow up nosebleeds of unknown cause. It could save you from an early demise.
    Gypsy
    11th Sep 2018
    8:31pm
    Happened to my mother. Arterial bleed at the back of the nose. ED did not pick it up for hours. In fact, a change of shift & a Dr realised what it was. She was never 100% after & had a massive stroke where it would have been kinder if she's died then. Instead she had a 2nd stroke in hospital and the 3rd which killed her, a couple of years later. Always check out a blood nose that's more than just a small one.


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