From the clinic
Things I end up explaining several times a day in the outpatient department, written down so you can read them slowly at home. This is general information, not advice about your own illness.
When a fever needs a hospital
Most fevers are caused by infections the body clears on its own, and most people who come to the OPD with fever go home with rest, fluids and paracetamol. What matters is knowing the small number of signs that mean you should not wait.
Go to a hospital the same day if the person with fever has any of these:
- Difficulty breathing, or breathing that looks fast and laboured
- Confusion, unusual drowsiness, or difficulty waking
- A fit or seizure
- Severe headache with neck stiffness, or dislike of bright light
- Persistent vomiting, so that fluids cannot be kept down
- Passing very little urine, or none for many hours
- Bleeding from the gums or nose, black stools, or a rash of small red spots
- Severe or worsening abdominal pain
Two groups need a lower threshold than everyone else. Any fever in a baby under three months old is a reason to be seen the same day, even if the baby looks well. And fever in pregnancy, in someone on cancer treatment, or in anyone whose immunity is known to be low should be assessed early rather than watched at home.
Otherwise, a fever that is settling by the fourth or fifth day is usually behaving normally. A fever that is still climbing after five days, or that settles and then returns, should be looked at.
Two things not to do while you wait. Do not start an antibiotic from a medical shop on your own: most fevers are viral, antibiotics do nothing for them, and taking them casually is a large part of why they stop working when they are genuinely needed. And do not stack painkillers — paracetamol is the safe choice for fever, and the medicines sold for pain and inflammation can make bleeding worse in dengue, which is common here in the months after the monsoon.
What to bring to an OPD visit
A doctor in a busy outpatient department may have a few minutes with you. How much of that goes on useful thinking rather than reconstructing your history depends almost entirely on what you walk in carrying.
Bring these four things:
- Every old prescription and report, in one folder, oldest at the back. Not a selection of what you thought was important — the whole lot. A blood test from eight months ago frequently changes what I do today.
- Your current medicines. The actual strips are better than a list, and far better than a description. “A small white tablet at night” describes several hundred drugs.
- Anything you have reacted to before — a drug that caused a rash, swelling or breathlessness. Say it at the start of the consultation, not at the end.
- One question, written down. People routinely remember what they most wanted to ask on the walk back to the bus stand. Writing it on the back of the old prescription solves this.
Two more that help. If the patient is elderly or unwell enough to be confused, someone who knows the history should come along — not to speak over them, but to fill gaps. And try to be able to say when the problem started, even roughly. “Since about Dussehra” is genuinely more useful than “for a long time”.