September 24th, 2012

Quick Question: An Etiquette Column for ID Specialists

(First in what will undoubtedly be a recurring series.)

Hi Paul:
What do you do when someone in a non-medical setting gets something really wrong, and it’s in our field? Here’s why I’m asking: I was picking up my 9-year-old son from school the other day, and his teacher reported to me that they were worried one of the other students “had gastroenteritis” — he was sent home with diarrhea — but that they were reassured when they called his mother, who said it was “just food poisoning” so everyone at the school was relieved. I felt like telling her that basically these were the same thing, with the same implications for the other students, but I didn’t want to come across as a know-it-all, so I said nothing.
Your advice?
Bugged in Billerica

Dear Bugged,

I completely understand your dilemma. How many times have we (omniscient) ID doctors sat quietly with our friends, as they tell us things like “I’m sure this rare hamburger is safe since the meat came from [insert high-end food emporium here]”, or “I won’t get sick traveling to India since I’m staying only in business hotels,” or “I thought this cough was just a virus, but then it was actually bronchitis.” In your case, it’s the “Food poisoning ≠ infectious risk, so no worries.”

Wrong, wrong, wrong, and wrong. But how dreary our company would be if we were constantly lecturing people on the facts. So how should we proceed?

My approach is to intervene — gently — only when someone’s misconception is potentially harming them or others. Here’s some practice language for our examples:

  1. Rare hamburger: “I agree Whole Foods [oops, mentioned it] has great meat, but I’m pretty sure even they recommend cooking hamburgers thoroughly.”
  2. India trip: “One of my ID colleagues travels a ton for his research, and he says India can be tricky.”
  3. Virus/bronchitis: “I hope you feel better soon.”

So what should you have done at your kid’s school? It depends on the setting. If you had the time, saying something like, “Well, you know good handwashing always makes sense, maybe this illness can be a reminder,” possibly prefacing this comment (if you’re feeling didactic) with, “Food poisoning and gastroenteritis can be the same thing.”

But what you really want to avoid doing is creating false alarm — so asking the teacher to quarantine the sick kid when he returns and to start collecting stool samples from all the other 4th graders would be way out of bounds.

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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

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