We all know those dreaded four letter words that, as children, we dared not say on penalty of having our mouths washed out with soap. Today, I diagnosed a friend with a viral upper respiratory tract infection. Upon hearing the word “viral,” my wife remarked, “viral has one letter more than a four-letter word yet it’s just as nasty.”

My family always hated it when I pronounced that the cause of their illness was viral. It was not uncommon to hear my wife say, “I don’t care if it’s viral, I want an antibiotic!” My family is no different than the rest of the world. When they are sick, they want pills.

I hate viral infections. It takes me three minutes to prescribe an antibiotic; and, in the eyes of my patient, I am a hero. It takes me ten minutes to explain why I’m not giving my patients an antibiotic, and they walk out angry! Antibiotics do not kill viruses.

“Dr. Segal didn’t even listen to me. He spent 30 seconds in the room, told me I had a virus, and sent me home to die from this horrible sore throat!” The patient did not hear anything I said after “antibiotics won’t help.” I wish I had a prescription placebo!

I have written multiple articles explaining how docs make diagnoses and treat illness. Unfortunately, most people are too busy making a living to take the time to read about healthcare.

When you are infected (sick), you need to know two things:

  1. Where is the infection? 
  •  What organism is causing the infection?

In the real estate business, it’s location, location, location! It’s the same in illness. When your doc uses words like pharyngitis (infection in throat), bronchitis (bronchi), gastritis (stomach), and pneumonia (lungs), he is defining the location where the illness resides. Think of infection as a crime. Location tells you how potentially serious the crime may be. (Generally, infections in the throat are less threatening than infections in the lungs.)

My brother has been in law enforcement for many years. His job often entailed identifying which criminal(s) perpetrated the crime. He had thousands of potential suspects. I have it relatively easy. My criminals fall into three classes: viral, bacterial, and fungal. Fungal infections are relatively rare so my job boils down to differentiating between bacterial and viral perpetrators. Bacteria respond to antibiotics; viruses do not! Your body has to kill viruses. (Your body can kill bacteria, as well; but antibiotics can help.)

After 30 years as a doc, I can tell you that deciding between viral and bacterial causes of infection is often difficult. I would like nothing more than to prescribe a harmless antibiotic to every patient who comes to see me with an infection. The problem is that I don’t have a harmless antibiotic.

Antibiotics come with risks. Antibiotics can cause allergic reactions, nausea, diarrhea (sometimes potentially life threatening), yeast infections, and something docs worry about called bacterial resistance. Treating patients always involve a risk-benefit ratio. Treating a virus with an antibiotic has no benefit, leaving only risks. 

So, to my patients and family I’d like to say, “I’m sorry you have a virus! The good news is you should be better in a week or two. The bad news is that antibiotics can’t help you.” Eat well, rest when you can, and drink plenty of fluids. See your doc if you get worse as he/she could be wrong about the diagnosis or you might develop a secondary infection.

Yes, “virus” is worse than a four-letter word. Unfortunately, it’s a word we can’t avoid!

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