Why do we see uncomplicated acute cough?
As experienced healthcare professionals, we have (or should have!) an in-depth knowledge of medical problems. When patients come to us with what we think is a trivial complaint, we should be tolerant and understanding. It is often crucial to understand what prompted the patient to attend and, in particular, what their underlying fears are. This may seem basic stuff, but it is always good to reflect on the core essentials of clinical practice. Getting the basics right provides us with a platform to ensure we provide our patients with high quality care.
This is particularly relevant at this time of year, when we see plenty of coughs and colds, even though many cases do not present to a healthcare professional. Reasons why patients present with cough often include a fear of pneumonia, the expectation of obtaining antibiotics and worry that the cold is "going to the chest".
A recent article in the Univadis Medical News service provided further insight into to why some patients present with cough (click here). The article reports: "Patients may request antibiotics for coughs because they greatly underestimate how long it usually takes for an acute cough to clear up, US research suggests." According to the study, many patients think that an acute cough may last between 7 and 9 days, whereas in reality it can take double that amount of time.
In primary care when faced with a relatively well patient with an otherwise uncomplicated acute cough and no significant comorbidities, it is important to think about what their concern is. Obtaining a good history and carrying out a focussed examination, followed by providing an understandable explanation, is all that may be required with no need for any prescription, particularly of an antibiotic.
This useful research article will help me in guiding patients to understand the natural history of their condition. Hopefully, by giving them more appropriate and accurate advice, this may reduce the unnecessary use of antibiotics. It is this kind of research that front line health professionals need. Equally important, this research should receive widespread publicity particularly through standard, popular media. However, because it is not a headline grabbing concept these findings may not reach out to the audience that they deserve, which is a shame.
Dr Harry Brown, editor-in-chief Univadis
By Dr Harry Brown