I’m off to the walk-in clinic in a little while. If past experience is a useful guide, I will see at least a dozen people with various respiratory viruses causing colds, conjuntivitis, bronchitis, and sinus infections (offending viruses include adenovirus, rhinovirus, and many others). Generally, the folks giving a home to these bugs need grandmotherly advice. Part of my job is to determine which of these patients might have an infection with Group A beta-hemolytic Streptococcus, Bordatella pertussis, Mycoplasma pneumoniea, Steptococcus pneumoniae, influenza, or other potentially bad actors.
There will probably be a few cases of gastroenteritis, most caused by enteroviruses like echovirus and norovirus, but I have to keep in mind other possibilities like Clostridium difficile, and Salmonella.
There will certainly be some sexually transmitted infections with organisms such as Neisseria gonnorrheaea, Chlamydia trachomatis, and Trichomonas vaginalis. That’s a fun one.Most of the time, we have to make educated guesses as to which microorganism we’re dealing with, but we can see Trich right away under the microscope.
Of course some of the friends I meet today might not be “micro”-organisms. Scabies and pubic lice sometimes grace my exam room.
Often enough, I treat small abscesses. Community-acquired MRSA has become so common that I usually pick an antibiotic to which it is susceptible, rather than the usual MSSA coverage (although, sometimes removing the “good and laudible pus” is enough).
Occassionally, I will meet a problem that can’t be dealt with in the clinic. Last week a man walked in with leg pain and shortness of breath. He had just returned from an extended car trip. His let was swollen, his lungs clear, and his EKG showed a pattern or right heart strain. We sent him straight to the ER where he was diagnosed with multiple pulmonary emboli and admitted to the hospital.
And this is part of the fun of primary care medicine. Seening a large variety of problems, sorting out the small problems from the dangerous ones, and passing on that knowledge.