The Stuff of Primary Care and A Duty of Care

Nearly 90% of patients who visit Primary Care clinics or General Practitioners suffer from respiratory conditions. While many of these are due to viral infections and therefore do not warrant an antibiotic therapy, a small proportion of others are due to allergic reactions giving rise to an asthma.

It is therefore important for a doctor especially at this point of contact to examine the respiratory system especially listening to breath sounds to determine a diagnosis which ensures a proper treatment for the patient.  Sadly many doctors, possibly due to the heavy attendances or simply negligent, have not conducted this step satisfactorily.

I have recently attended to a 10 year old boy who has been coming to the clinic since August 2012 for recurrent coughs. The first time he came he was given the usual anti-cough mixture, the second time it was the same, the third time the doctor ordered a sputum for AFB ( Acid-Fast Bacilli) for suspected TB (tuberculosis) and given a double antibiotic regime as he thought the child could have pneumonia despite not having any fever. The recurrent coughs had never stopped and the father kept bringing the child and another two sputum AFB were ordered and I noted only one test came back without any report as the samples were said to be not satisfactory. I also could not find the chest x-ray ordered by the third doctor and so reluctantly have to order a new one which I was not happy about.

There is no continuity of care for this child who is rather quiet. He was seen by four different doctors before coming to me. It didn't help that the child kept denying that he had breathing difficulties especially after physical exercise. I took his blood sample to see whether his hemoglobin level is normal as though he has no pallor, his father insisted that he has not been eating well. The boy's Hb level was good at 13.4g/dL.

I did a full examination of his respiratory system and listen intently for his lung sounds and detected the mild wheezes. I made a diagnosis of asthma and treated the child accordingly and the coughs have since been reduced and the father is very happy to at last be told of the diagnosis and how to deal with the condition.

It is very important to make a firm diagnosis in this case and relieve the family of the anxiety about their son's intractable condition. Listening to the chest properly and defining the sound relating to which part of the respiratory tree that is causing the sound is therefore critical in this case.

Needless to say, the best confirmatory test for the diagnosis of asthma is to perform the respiratory function test namely spirometry on this 10-year old child for which the father has to take him to the hospital as unfortunately the facility is yet to be made available at our clinic level. This test will also determine the severity of his asthma.