Aychamo BanBan
<Banned>
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I may have exaggerated regarding being sued over missing a strep throat, I've not heard of it, but I still will practice in my patient's best interest. But check this Strep throat algorithm from the American Academy of Family Physicians (below.) What would you do with a Centor of 1-3 in a patient with poor follow up where you cannot get a Rapid strep because their insurance wont pay for it? Culture will take > 1 day, and their phone number is likely fake anyways (ie, in an emergency room.) Or, same situation, but it's Friday in the clinic and it's an extended holiday weekend. Gotta treat them. Especially if their parents are so horrible that they don't even have a doctor they take them to regularly for their kid med (preventative medicine) visits. I don't want the kid to suffer because their parents are idiots, so if I have them in the ER, or a rare office visit, I'd treat because there's no guarantee that kid will see a doctor again for any certain period of time. Now, if it's in the ER and the patient does have a PCP, and you feel they have good followup, you can just document all of that and have them follow up, etc.Don't you have guidelines that save your ass? In Canada, we are only obligated to empirically treat if it without a doubt looks like GAS throat (ie. no cough, exudates, lymphadenopathy, fever) AND there may be an issue with follow-up or testing in a remote community. Even with those 4 cardinal symptoms, you still have only 44% likelyhood of actually having GAS pharyngitis. Everything else gets a swab and if it looks like viral (rhinorrhea, congestion, cough, etc) it doesn't even deserve a swab.
I'm sure many of these scenarios don't apply to Canada because of the differences in our health care systems.