In my pharyngitis talk, I now use the phrase "just a sore throat". A Google search on the phrase gets over 1.5 million hits. Why is this phrase dangerous?
When one studies cognitive errors, a major problem is the anchoring bias.
Anchoring or focalism is a term used in psychology to describe the common human tendency to rely too heavily, or "anchor," on one trait or piece of information when making decisions.
During normal decision making, individuals anchor, or overly rely, on specific information or a specific value and then adjust to that value to account for other elements of the circumstance.
So the problem is rather obvious. When a patient comes to the emergency department or physician's office with a sore throat and other symptoms, too often physicians discount the other symptoms, because that patient illness is "just a sore throat".
Here is another classic example of a presentation of Lemierre's syndrome. Dean's Fight With Lemierre's
Dean's mother sent me an account of his illness. Here is the part prior to the diagnosis:
Like all Lemierres victim's Dean started out with a bad sore throat.
Dec. 16, 2009 – complaining of a sore throat
Dec. 21, 2009 – first faint case of rigours (no fever yet)
Dec. 22, 2009 – vomiting and diarrhea – slight fever
Dec. 23, 2009 – Dr. Visit – misdiagnosis – Gastrointestinal flu – Prescribed anti-vomit med's
Dec. 24, 2009 – Elevated fever – 104 – ER visit for 8 hours – sent home after fever was regulated
Dec. 25, 2009 – Elevated fever 104 – and increased rigors and complaint that his 'lungs hurt' -ER visit – sent home after 8 hours – prognosis 'viral', "it'll work itself out in time, nothing you can do" – prescribed Zofran and Motrin/Tylenol every 4 hours.
Dec. 27, 2009 – Rigours much increased – fever every 4 hours controlled by Motrin/Tylenol – complaint that his shoulder and foot hurt really bad.
This young man had multiple clues to his diagnosis. His physicians suffered from anchoring and likely a lack of knowledge that some sore throats start more serious infections.
This must be our educational mission. We must continuously remind physicians of the "red flags" for sore throat patients.
{ 1 comment… read it below or add one }
Hi
My husband presented with a sore throat on the 14th December and compained of a stiff neck and general fever.He visited the Doctor whom perscibed him cocoldamol,and tomazapane.As he was working considerably alot over this period he didnt take the Tomazapan.on the 21st Dec ,buy which time he was getting vigorous shakes and his neck had developed a lump he visited the doctor again who gave him antibiotics and told him to return on the 23rd December.He felt extremely lathergic and the lump on his neck was getting larger,also he was having hot and cold sweats and seemed to be looking very gray.He visited the doc again on the 23rd and was admitted to hospital and put on iv drips,on the 24th Dec he was moved to another hospital for scans.The lump on his neck by this time was getting extremely large but still no diagnoses was given.His condition seemed to improve on the 28th Dec and on the 30 dec he was transfered back to the 1st hospital.he had had numerous scans and needles incerted into his neck.On the 30 dec we were told he could be discahrged the following day,although the lump was still large.The doctor told us it could be lymphoma,he then got a vascular surgeon to have a look and he said he had only seen this condition once in his career and said he thought it was "no blood in the jugular vein".He was sent for another scan and discharged from the hospital with a sick note stating lemierres syndrome.He is getting better and hoping to return to work next week although he still has a slight lump on his neck and is having another mri scan next week.If anyone would like any details pls feel free to email me Helen.masheder@futuretravel.co.uk