As an adult, how do you decide when you're sick enough to go see a doctor?
December 6, 2012 6:56 AM   Subscribe

As an adult, how do you decide when you're sick enough that you should go see a doctor?

I think I need some guidelines, or maybe a decision-making tree, for when you should go see a doctor, and when you should just stay home and drink tea and sleep on the couch for a couple of days. My main problem I think is that I don't have any models for that kind of decision-making: my dad never goes to the doctor unless he's cut off a toe or something, and my mom is a hypochrondriac who thinks that any scrape that looks slightly red around the edges is probably infected with flesh-eating bacteria. Basically, I grew up in a house with no middle path.

In addition to not having any models, I am stubborn, accustomed to having to take care of myself, and I probably have an un-usefully high pain tolerance to boot, which means that my general mode of operating goes like this: I start feeling sort of crappy for some reason, but not debilitatingly so. It doesn't even occur to me as an option at that point to slow down for a couple of days and take care of myself, so without really thinking about it, I just end up putting my head down and working harder to overcome the fatigue, etc. I continue on working like that until I am literally too sick to move or until something makes it suddenly apparent to me how much ground I've lost. Then I go to the doctor, half expecting them to laugh me out of the office for being a hypochondriac. But instead of laughing at me, the doctor often tells me that I'm actually a lot sicker than I'd been thinking.

Altogether, this means that I've lost a lot of time to feeling sick. But I feel like there have to be people out there who have this better figured out than I do: who manage to go to the doctor in a more timely manner than I do. If you are one of those people, how do you do it? How do you decide what counts as sick enough to go to the doctor? If you decide to wait for a little while and see if something resolves itself on its own with a little self-care, how do you decide when to stop waiting if it doesn't get better right away? And, maybe this is a weird question, but if you're used to being chronically ill, how do you notice when something has changed from being "sort of normally sick" to "okay, this is a problem that requires attention"? I apologize in advance if this question is a little incoherent. It was prompted by the realization that my earache has been getting steadily worse for a month and a half now, and it's now bad enough that I can't really hear out of that ear, so I should probably go to the doctor tomorrow. Anyway, I'm a little foggy at the moment.
posted by colfax to Health & Fitness (29 answers total) 19 users marked this as a favorite
Best answer: A doctor is never going to make fun of you for coming to see them. I go to the doctor if I'm sick enough to stay home from work for more than a couple of days, or if I have some kind of specific problem that is bothering me enough to occupy my thoughts. For your earache example, I wouldn't have put up with that for more than 3 days or so.

My mom is a nurse and her instruction to me is that you should also go if you have a persistent fever of above 100 degrees.
posted by something something at 7:01 AM on December 6, 2012

Best answer: Well it also depends on what you have and your timeliness. For example, mine is downtown and if I'm sick at home where it's say an ear infection or something like that, you can also just go to a care clinic for simple stuff. Where something more serious like perhaps bronchitis or is this strep, you may want to have your primary take care of it.

Usually the rule of thumb is multi symptom + fever + how many days.

For example:

high fever over 101, chills, aches = probably the flu or a virus. Give it a few days (5). If lasts longer, especially if fever cannot be controlled w/out ibuphrophin -- go to the doc just to make sure.

any severe or odd stomach pains, chest pains, bowel/urine issues (like blood) go se the doc.

From someone who went to the ER three times for severe stomach pains, vomiting, and losing weight, trust me, ERs are good at blood, gore, heart attacks. Unless you're bleeding and it's something near death---they look at you like you're crazy. Try your primary first and have them get you into a specialist (ex. the stomach pains required a endoscopy, CT scan, etc).

Things you don't want to get out of control are infections, very severe/odd headaches beyond a migrane, speech slurring out of the blue, numbness, or things that last longer than 7 days. Never be ashamed/afraid to go to the doctor. They are there to serve you and you are paying them. If you don't like what they have to say, move on to the next one.
posted by stormpooper at 7:03 AM on December 6, 2012 [1 favorite]

Agreed with above. I wait things out for two or three days and try to do whatever home remedies I think I need, and if things are getting worse or things are really bad with no improvement, then it's doctor time.
posted by greta simone at 7:04 AM on December 6, 2012

Best answer: It was prompted by the realization that my earache has been getting steadily worse for a month and a half now...

If you've been having some sort of pain for a month, that is way, way too long. Generally, if something isn't right or hurts or looks funny or is leaking fluid, and you did whatever first aid/home remedy you know about and it got worse, make an appointment that day. Very, very few things that get progressively worse go away on their own, and the ones that do aren't worth the risk.

There is an objectively negative value to not seeing the doctor when you are clearly ailing. That is the long and short of it.
posted by griphus at 7:04 AM on December 6, 2012 [8 favorites]

This isn't all that weird, because of the expense of going to the doctor, so many of us usually wait until it's a big hairy deal.

If it's Flu, Bronchitis, Walking Pneumonia, it's a hard call.

Typically, if I just feel like shit, I rest. I don't miss work unless I'm so nauseated that I can't move. So at the most, I'm out one day. I may still feel bad, run a fever, but if I can do some TheraFlu and get my ass to work, I will.

I think we go to the doctor when we've tried everything and we're all out of ideas. If Robitussin doesn't cure it, the doctor can recommend something.

If I have a sore throat and fever, it might be strep, so I'll go to the doctor. Other than that, I'll suffer. Anything with pain and fever might be bacterial, so I'll go to the doctor. Earaches, I'll go that day.

One thing to do is get in the habit of going to the doctor for an annual check-up. That way you have a relationship. Also, ask your doc. "Dude, when should I come see you?" He or she should have some good guidelines.

Husbunny was a Nurse, so I get a professional opinion if I'm on the fence.
posted by Ruthless Bunny at 7:04 AM on December 6, 2012 [1 favorite]

Best answer: I have no metric for that sort of thing, so I consult either

- friends who know me who have better internal compasses for this sort of thing
- one of those decent doctor books or websites like Mayo Clinic which usually has a section that is specially "When to go to the doctor?"
- call the number on my health insurance card and ask them (this led to me getting my broken ankle looked at quicker than I would have otherwise, thanks health insurance!)

Short list: If I think something is infected, worsening or a recurrence of something that has gotten me antibiotics in the past (like a sinus infection) I'll go in sooner. If I have pain that is preventing me from sleeping, I'll go in sooner. If I just feel punk with a cold or flu, I won't go in unless I have any of the danger signs like a high or spikey fever or trouble breathing.
posted by jessamyn at 7:05 AM on December 6, 2012

I think I need some guidelines, or maybe a decision-making tree, for when you should go see a doctor, and when you should just stay home and drink tea and sleep on the couch for a couple of days

For illnesses, I give something one week to just go away on its own. 90% of the time it does. If it doesn't, then I will see a doctor about it. Things like eye problems that won't go away I will probably see a doctor sooner about.

For some perspective, by following that rule, I haven't been to my primary care doctor in about 2.5 years, though I did go to an emergency room for stitches, once.

It was prompted by the realization that my earache has been getting steadily worse for a month and a half now...

From my "I never bother to see a doctor because it's usually unnecessary" perspective, it definitely sounds like you should see your doctor about that.
posted by deanc at 7:08 AM on December 6, 2012 [1 favorite]

If you've been sick with a cold for more then five days, and on the 5th day you are not seeing major improvements, go to the doctor. If you're not 95% better after seven days, go to the doctor.

If you have a fever over 101 degrees go to the doctor.

If you can't breathe or you feel like your chest is tight, like there's a 20lb dog sitting on it, go to the doctor.

If it keeps bleeding go see a doctor.
posted by royalsong at 7:12 AM on December 6, 2012 [2 favorites]

We have a household rubric (prompted by my biannual puking festival) to determine when someone needs to go to the ER.

Any of the following conditions must be met:

-Cannot walk
-Slurred speech
-Can walk and talk but not making sense, AND cannot keep down liquid

Go directly to ER for saline and, if there's severe cramping, hopefully morphine. Otherwise, wait it out with your face to the bathroom tile.
posted by chesty_a_arthur at 7:13 AM on December 6, 2012

Best answer: I only go if I realistically think there's anything that the doctor is going to be able to do for me that I can't do myself. Doctors aren't magic, and if you go to the doctor with a cold on the first or second day you're feeling lousy, chances are they're not going to do much more than to tell you which over-the-counter drugs to use. So I don't bother going if I suspect I just have a regular seasonal cold or flu, absent some extenuating circumstance.

However, it's worth going IMO when you're either feeling something that's definitely outside your experience — "wow, I've never felt this bad before" — or you're feeling like you're going downhill (i.e. not just that you feel bad, but you feel like you are already feeling bad and getting worse). Or if it's something that you know from experience the doctor will treat effectively that you can't deal with at home (e.g. UTIs or other infections requiring antibiotics). Anything that keeps your body from performing a normal function is worth going in for (e.g. sore throat = stay home; sore throat where you can't swallow = doctor ASAP). And of course, anything that causes you difficulty breathing is not just a doctor visit, but getting into call-an-ambulance territory, particularly if you're by yourself.

Or, as others have said, if you're not responding to the usual OTC drugs or just not getting better in the usual amount of time, then it's probably time to go. The key is knowing yourself and what's normal when you get sick.

If you have friends you trust, listen to them if they say you should go to a doctor; it's easy to not notice if you're getting worse, but someone else might notice the trend. And if you live by yourself I'd probably be a bit more aggressive about going than if you live with someone, just because of the logistics of getting yourself to the doctor when you feel really shitty.
posted by Kadin2048 at 7:15 AM on December 6, 2012 [2 favorites]

Does your HMO have a nurse line? They're very helpful for gauging the severity of your issues.

If you're having trouble breathing... yep, go see a doctor.

If you have symptoms that can't be relieved through OTC drugs or rest... yep, go see a doctor.

If you have pain that doesn't go away, or pain in one of those weird areas that you've never had (or pain in your chest that you're not sure is related to strain or, like, pneumonia)... yep, go see a doctor.

A doctor is never going to make fun of you for coming to see them.

Lucky you! I got yelled at while sobbing in worry that I'd get kicked out of school (a vocal program). The doctor at my HMO said, "You college students; you think you're so smart. You know what you have? You have a COLD."

"Bu-bu-but it's been three weeks and my sore throat hasn't gotten better..."

"People DIE from colds."

And then she refused to test me for mono, which led to a final diagnosis a full month later at the campus health center. It was, in fact, lupus... er, mono.
posted by Madamina at 7:18 AM on December 6, 2012 [2 favorites]

For respiratory ailments (coughs, earaches, sinus infection, snotty head rendering you semi-functional), I usually wait 10-14 days and treat with home care as long as I can at least semi-function, which is usually how long they'll tell me to try to wait it out, so I can move directly to the "seeing the doctor" part if I call the nurse and say, "I've been sick with this for two weeks ..."

When in doubt, call a nurse line and ask the nurse what sort of home care you ought to be doing, or if you ought to see the doctor. That's literally exactly what they're there for; they pre-triage you and give you good suggestions for home care and OTC meds you might not have thought of ... or tell you, "Yeah, you need to go see a doctor with that." They also say, "If you're not seeing any improvement in 48 hours, you need to go to the doctor." Or, "If you start to develop a rash, go right to the ER." Or whatever.

A lot of hospitals have after-hour nurse lines (in the hopes you'll call it before going to the ER with something non-ER-worthy), and most insurance companies have them. Plus your doctor probably has a nurse who just takes and returns all those sorts of calls during normal business hours.
posted by Eyebrows McGee at 7:19 AM on December 6, 2012 [1 favorite]

My own personal rubric:

Make a doctor's appointment: if the symptoms you're experiencing are not brand-new to you but have persisted or increased in intensity for more than a week, OR if the symptoms are new to you but to not interfere with your basic daily functioning.

Go to urgent care or the ER: if the symptoms of your illness are new to you and DO interfere with your basic daily functioning (e.g. "I cannot see out of one eye"), OR if you are unable to keep down clear liquids for more than 12 hours.

Go to the ER: if a part of your body which previously functioned abruptly malfunctions or stops functioning, whether by itself or by trauma, OR if you are having legitimate trouble breathing, OR if you are having any neurological symptoms, OR if you are experiencing persistent pain of unprecedented severity which is not due to gas or food poisoning, OR if you are bleeding from a non-minor injury and the bleeding continues to soak through the dressing after half an hour of applying pressure.
posted by julthumbscrew at 7:25 AM on December 6, 2012

You don't say what country you're in, but in the UK the NHS Direct phone line and website will go through your symptoms and give you advice on whether you should treat it yourself, make a doctor's appointment, or go to the ER.
posted by EndsOfInvention at 7:43 AM on December 6, 2012

The first apartment I lived in as a college student was with 4 guys of varying age and stonerability. Our metric for when someone's mom was called to come get them was if we went more than 5 days without getting high or jerking off.

As a somewhat more reasonable adult (lol lol lol) I have adapted this to slightly different parameters: if I've gone 5 days without being able to eat properly or get out of bed/off the couch, or if I've used my asthma inhaler more than 10x in one day, etc. (It's hard to stick to it when you're really sick, though, because it is really difficult to make good and informed decisions when you have 103 fever.)

Always immediately go to the hospital if there is blood coming from places where blood does not normally come from, or if you have been losing high volumes of fluid from both ends for 48h or more.
posted by elizardbits at 7:52 AM on December 6, 2012 [1 favorite]

Some "family medical guides" (the dead tree versions) have a decision tree (should you self treat, call your doctor, go to the ER etc) for various symptoms.
posted by oceano at 8:10 AM on December 6, 2012

I call my doctor's office and talk to one of the nurses. My doctor has a dedicated "phone nurse" for exactly this kind of decision making. It's really helpful.
posted by medusa at 8:12 AM on December 6, 2012 [2 favorites]

Best answer: If you're an independent sort, then you might want to bookmark the online version of the Merck Manual Home Health Handbook, which also has a dead-tree version available. Here's their section on earache, which lists the symptoms and their causes, but also has treatment guidelines (i.e., go to the doctor for this and not that).
posted by evoque at 8:43 AM on December 6, 2012

WebMD has a symptom checker that does a pretty good job of narrowing down what you should do in terms of giving it a day or so, or calling your regular doctor, or going to the ER or what.

Other than that, my rules of thumb are:

1. Anything that feels just like a nasty cold, just chill at home. Same with vomiting once or twice. If either one persists for two days or gets worse, call your doctor. Do not be alarmed if they tell you to keep chilling for another day or two, though.

2. If you got a fever of about 101, call your doctor. If your fever is higher than 103, though, that may be time for the ER.

3. Anything involving moderate to severe bleeding or bad* abdominal pain - ER. Or, at least call your doctor and ask "should i come see you first or just go to the ER?".

* My own benchmark for "bad" pain is: pain that is so bad that it causes you to black out momentarily, and then throw up. And yes, I have experienced that.
posted by EmpressCallipygos at 8:46 AM on December 6, 2012

It sounds like you have insurance, so you have access to a nurse line - that's my first step if I'm not sure I need to go to the doctor.

Here is what I personally would do; IANAD, this is not medical advice:

- Can't keep down anything including water = ER immediately
- Can't keep down food, can keep down liquids = give it 24 hours, then regular doctor (or urgent care).
- Vomit a couple times = drink extra fluids, rest
- Fever under 102ish = Wait a day or two, maybe call the nurse line & talk about my symptoms and get advice.
- Fever around 103 = absolutely call the nurse line or the doctor
- Fever around 104 = Call 911; risk of brain damage!
- Ear pain - I might wait a day, but I'd probably just make a regular doctor's appointment right away, to see if I need antibiotics
- Stuffy nose, general lack of energy, feeling crappy, sore throat, but no fever = drink extra fluids, rest, wait a week. If I'm worse after a week, I'll make a doctor's appointment, if I'm starting to feel better, I'll just keep taking it easy.

Also, if you want to be more productive / get more done at work, consider taking a day off to rest when you start getting sick. Sleep a lot, drink extra fluids, and you might end up with a mild cold instead of a severe one and in the long run, you will get more done at work. Working harder when you are sick usually means getting sicker and ending up needing more time off in the long run.
posted by insectosaurus at 9:43 AM on December 6, 2012 [1 favorite]

I go when sleep, Tylenol, Benadryl, and Advil don't have any impact on my symptoms or pain. I have gotten pretty good at assessing when I have a sinus infection, a UTI, or stomach problems outside the norm so I can self regulate my visits along those lines.
posted by These Birds of a Feather at 9:45 AM on December 6, 2012

This kind of remind me of those homeowners on TV that neglect their houses so much but pretend everything is fine. Their biggest fear is that their house has damage, but instead of addressing and fixing the issues, they pretend that the damage doesn't exist and live their lives around it. These neglectful homeowners often have this idea that if they can't see the problem, then it must not exist. That's why their houses often have sagging ceilings, walls covering up significant mold damage, or severe pest issues.

The one thing in common with all these neglectful homeowners is that they avoid addressing issues, mostly because they know nothing about house maintenence. They don't know anything about the structure of the house, or how to fix leaky pipes, repair a wall, or address mold problems. And since they don't know, they conclude that it's not a legitimate problem.

To tie it back to you, this is why it is very important to really know about health issues. Knowledge is power. Make sure you aren't purposely avoiding learning about health issues because of the stigma with your mom. You mom's lack of sufficient health education is probably the exact reason why she's a hyperchondriac. She probably gets all her health information from alarmist news articles, or from horrible tales told by co-workers. Details in these stories often get skewed or skimped, and I highly doubt that she has verified any of the details, or has done a little legitimate research on health, beyond WebMD. People like her want to believe that they are sick in some way, and that's how you differ from your mom. You don't want to be sick.

I suggest you should legitimately study up on some health issues, or perhaps even take a first aid course. I'm not saying you should become an expert at cancer or anything, but a little knowledge goes a long ways, and as long as you don't get your health news from the media, you won't end up like your mom. Knowledge is power, and knowing a little bit about how the body works and the symptoms of major illnesses can go a long way. For example, you have an ear-ache right now. Have you thought to pay attention to any other symptoms that you might be experiencing? Are your lymph nodes inflamed? Do you know where your lymph nodes are? Is your throat sore also? Does taking ibuprofun help with the ear pain? Did you know that ibuprofun helps reduce inflammation?

In addition to being proactive about learning health issues, I suggest that you take the opportunity to ask some questions everytime you see your doctor. For example, you can explain to him that your mom thought a cut was a flesh eating disease, but it turned out to be okay, however you realized that you didn't know the difference between a normal cut and an infected cut. Your doctor should be able to explain the difference between the two so you can make a better assessment next time.
posted by nikkorizz at 10:08 AM on December 6, 2012 [1 favorite]

Best answer: I'm a doctor.
For most minor illnesses like stomach bugs, colds, coughs, flus, the "wait a week" guideline is great (if it's significantly worsening in that time, I wouldn't wait the whole week, though). I so often see people in the ER who have had symptoms for one day or who haven't tried taking anything for their symptoms, but it is clear you are not that sort of person.

Common myths about when to visit a doctor "I took ibuprofen or Tylenol for a fever, but the fever came back!" - the medication treats the symptom. When it wears off, the symptom comes back. That doesn't mean anything about how severe the illness is. "I have a fever. I must be really sick" Well, a fever certainly is a sign of infection, but you can get a fever with minor illnesses as well as with major ones. A fever itself is not really harmful- the infection causing it might be.

Here are some examples of things that people would often visit their primary care physician for if they were persistent: mild to moderate headache, upper respiratory infection, stomach bugs with vomiting/diarrhea, earache would also fit here, as would sore throat, UTI symptoms, muscle strains/injuries that might be either sprained/bruised or broken.

Here are some examples of things that people often visit the ER for (or possibly primary care if the PCP does same day appointments): more severe versions of the above, i.e. moderate to severe headache or sore throat, more severe injuries that are probably broken (obvious deformity of a bone, inability to walk/use the affected body part, severe pain), abdominal pain that is moderate or more, asthma exacerbation/respiratory infection that is mild to moderate.

Examples of things that people should not be waiting at home with or visiting their PCP for, in which people should go directly to the ER immediately: chest pain, shortness of breath, vomiting with inability to keep down fluids/dehydration, severe abdominal/pelvic/testicular pain, difficulty with speaking/breathing/walking/using an arm or a leg, serious injuries, skin infection with spreading red streaking/redness/pus drainage, headache with confusion or fever or any other neurologic symptom like numbness/tingling/weakness.
(in the above cases I would strongly recommend considering using an ambulance or at least having a friend or family member drive you to the ER, for safety)

There could be modifications to many of the above examples that would ratchet up or down the concern level, those are just broad examples. Calling a nurse line is a great way to get further guidance on how to address a health concern if it is unclear.
posted by treehorn+bunny at 10:54 AM on December 6, 2012 [16 favorites]

During cold/flu season, I try to keep track of how other people are experiencing such things. I have a tendency to develop bronchial infections (and probably to put up with them too long), but if everybody is still coughing after 2 weeks, I figure it's a grim bug this year and wait a bit longer. If nobody else is coughing at all, then I should probably wonder why mine is so bad (other than poor plumbing design) and give up on cough syrup after a few days...

As for injuries and pains, much good advice already above.
posted by acm at 12:24 PM on December 6, 2012

Part of it is also knowing how you respond to things. I know that I can count on one hand the number of times I have run a fever over 101 degrees as an adult, and each time was when I was really sick. So for me, a fever that high would be a clear indicator for me to seek medical attention, but for other people that might not be the case.

And, maybe this is a weird question, but if you're used to being chronically ill, how do you notice when something has changed from being "sort of normally sick" to "okay, this is a problem that requires attention"?

Experience, I think. While I don't think it qualifies as chronically ill, I used to get some pretty nasty sinus recurring sinus infections. After about a year after I started getting them, I could always tell when I had an infection.
posted by inertia at 12:51 PM on December 6, 2012

I n'th the idea of a first aid course (there really does need to be more formal education about health that is a middle ground between first aid and nursing school).

I wonder if journaling would help you though? Just every day at the same time write in a book or email a little bit to touch base with your mental/physical health : "Dec 5th, severe right earache: cannot hear tv at normal volume if I cover left ear, took two advils@2pm, feeling anxious for no descerable reason, odd bruise on left ankle." Maybe having a record, looking through it once a week for patterns, and forcing yourself to pay attention to things you normally neglect will recalibrate your health-o-meter. Slightly off topic but mediation is also very good for developing mindfulness and just focusing on your body and breathing (also frees you from distractions so you can tell the difference between an itch and an ouch).
posted by saucysault at 1:50 PM on December 6, 2012

Best answer: For the non-emergency kind of illnesses, I write on my calendar the first day I notice it. (Things like sort throat, head cold, cough, fever under 101, very low energy, earache, bugbites or rashes that aren't spreading/getting redder/getting warm.)

I found it was easy to let these things go, and then think "wait, I've been feeling crummy for a while but how long has it been?" - so it works better for me to write it down the first day. Then I have a benchmark for calculating my 10-day (or whatever) wait time, and a little reminder to check in with myself about whether it's getting worse. It almost always resolves itself, but for the cases where it doesn't, it's nice to have that information readily available.
posted by LobsterMitten at 2:41 PM on December 6, 2012 [2 favorites]

I like LobsterMitten's idea of keeping track of the first day you feel bad. I do that sometimes, and it's really helpful, especially because the nurse/doctor likes to know.

Calling a nurseline is also a great idea, as people have mentioned.

I tend to be a little anxious when I get sick because I have asthma and have had some scary attacks in the past as well as bad pneumonia, bronchitis, etc. If you have an urgent care near you, that could be a good place to go if you start feeling worse and don't have a dr appt. It gives me peace of mind to remember that there is an urgent care center not too far from me that is open 7 days a week.

I decide to go to the doctor when I believe that I could have bronchitis or pneumonia, or if I get a lot worse, of if my chest hurts. I have had a congested (not painful) cough for two weeks now, and it was just a cough but today I have a runny nose and slightly sore throat. I was sick in October and was sure I had bronchitis but it was just a cold, so I'm not too worried right now about my current illness because it's not worsening.

Anyway, I feel your pain. My advice is to go easy on yourself when you start to feel sick, try to get a LOT of sleep and drink a LOT of liquids, call a nurseline if needed, and pay attention to how you feel each day. I hope your ear feels better soon!
posted by sucre at 4:10 PM on December 6, 2012 [1 favorite]

Response by poster: Thank you all so so much for your answers. A week, huh? Bloody hell. I wish someone had told me that about 10 years ago. Strangely enough, I've spent a lot of time in wilderness first aid courses, because I used to work in outdoor education. For some reason though I'm not very good at translating what I know about taking care of other people into taking care of myself.
posted by colfax at 3:11 AM on December 7, 2012

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