How to handle health questions semi-objectively
March 15, 2015 2:47 AM   Subscribe

My family had unusual ideas about health, illness and contagion, and now I have confused instincts about when to go to the doctor, and when to worry about giving someone my nasty cold. Do you know some resources or rules of thumb that might help?

1. I come from a family that is weird about illness. One thing that was weird with us was that we talked about being sick as if it were a terrible thing, almost a moral failing. Perhaps related to that, I experience health anxiety. I probably fantasized about having five serious diseases this month. Also I'm dealing with high levels of life stress, and my body is quite reactive to that stress. Finally, one of my closest friends died last year from a cancer that wasn't diagnosed until it was metastatic. So there's a lot of anxiety/psychosomatic activity/"noise" for me in the realm of health and symptoms.

I have symptoms. I will probably always have symptoms. Is there a book, or an objective method that I could use to know when symptoms really warrant going to the doctor, and when I ought to stay home and have a hot tea instead?

2. Another of my family's characteristics re: illness is that my parents both thought that sick people had an ethical imperative to stay home and not expose anyone to their illness.

As a result of growing up with that value, I often skip social gatherings and optional meetings, or decline to shake people's hands when I have a bad cold or other communicable illness. But I feel like people split down the middle between finding this admirable ("thanks for not exposing me to your viral bronchitis!") and finding it annoying and neurotic ("I can't believe you didn't come to my party because you said you have a cold!").

Has anyone written about this? I know that a lot of jobs don't have sick days, and that parents of small children often suffer perpetual snot. But is there any type of agreed-upon standard etiquette re: whether a mountain of mucus should cancel your optional social engagements or not?

(It would be nice if I could just make decisions based on my gut feeling. I have a therapist and am working on that. In the meantime, I'd love resources/rules of thumb to help navigate these areas where my internal compass doesn't function very well.)
posted by feets to Human Relations (15 answers total) 3 users marked this as a favorite
My rule of thumb for colds and such is that if I am gross (lots of sneezing, coughing, multiple packets of tissues) I stay home if at all possible, if I have to work I'll work remotely. Same if I feel flu like. If, on the other hand, I feel fine and suffer with low level symptoms I go to work and socialise.
posted by koahiatamadl at 3:52 AM on March 15, 2015 [1 favorite]

If you are even thinking about going to social gatherings I'm going to assume that you are not talking about illnesses where you literally cannot attend because you are bed-bound with a raging fever or suffering from, ahem, gastrointestinal distress.

In that case, unless you are meeting a newborn baby, someone very frail or someone otherwise immune compromised, I think that most people accept that maybe picking up some sort of malady is a given risk when attending a social gathering with lots of people and will be perfectly fine with having you there. You may get some gentle ribbing later down the line about having given them "your" cold, but it will mostly be just that - joking around.

With that in mind, the best compass for deciding whether to attend should be whether you feel up to it. If you feel like your illness will not prevent you from enjoying the gathering, go for it. If you feel that you won't have a good time because you are too snuffly and groggy or you feel like being a streaming mess makes you feel too unattractive to go out, then don't go.

Some people are always going to complain when you miss an engagement for any reason, be it genuine illness, a double booking or whatever. Those people are either A) Expressing their disappointment at not seeing you in a maybe slightly non-useful way or B) dicks. Shrug and move on.

With regards to casual intimacy like handshakes, hugs, etc: I think you are probably fine as you are. So long as you aren't refusing all human contact when you have even the suspicion that you are coming down with something, I think that most people will take a quick self effacing laugh and you saying "whoah there buddy, probably don't want to shake if you don't want to catch my cold" with good grace. That's fairly usual and I know I wouldn't mind.
posted by Dext at 4:08 AM on March 15, 2015 [3 favorites]

(This all assumes you are in the US )
1. It's really hard, even for people who don't have all the baggage you do. You can check with you health insurance company to see if they have a "Ask a Nurse" phone number. You can call and describe your symptoms and they will give you some advice, but keep in mind that they will err on the side of sending you to the doctor because, well, that's how they get paid, but they are also afraid of liability if they tell you not to go and you were really sick. Other than that, I think the best thing to do is sort of balance severity of symptoms with duration of symptoms. If you are really very sick you might want to go in immediately, but you also might want to be seen if you have had a decent cold for several days, or a very mild symptom for some weeks.

2. I usually base this on how apparent my illness is to others. If I am sniffling and coughing, or dashing to the bathroom every few minutes, that's not how I want my friends or co-workers to see me, but if it's just a sore throat or mild stomach upset, I'll probably tough it out. You also have to consider the importance of the event you are missing. Calling in sick when your team has a deadline looming or missing your friend's wedding is different from just missing a regular day of work, or begging off from your buddy's cookout. As Dext says, the calculations are different when you are going to be around someone you know to be immune compromised.
posted by Rock Steady at 4:21 AM on March 15, 2015

IANAD so the below is just my opinion.

A cold is only contagious for three days. Flu (which can almost always be differentiated by the presence of fever), is five days starting 48 hours after onset. There is no reason to avoid others outside these timeframes. And if you're not coughing or sneezing, and practice good hand hygiene, I'm not sure you're going to make an appreciable addition to America's one billion colds a year anyway.

You should know when to go to the ER, and work backwards from there.

Otherwise, unless you have a) fever that won't reduce with over-the-counter drugs, b) are in danger of dehydration, c) have acute pain or pain that is worsening, I would wait four to seven days to see if things improve before seeing a doctor.

But you seem like the absolute ideal audience for a Merck Manual! The book is a stalwart, and these days there is even an app if you roll that way.
posted by DarlingBri at 4:53 AM on March 15, 2015 [2 favorites]

I would say that if you are throwing up or have diarrhoea, please stay home to avoid passing your stomach bug on to others.

As far as I know, colds and flus are contagious even before you have symptoms and it can take a few days for symptoms to start, so I think it's kind of useless to quarantine yourself. If you're sneezing and coughing and have a runny nose and have to blow your nose all the time etc. it's polite to stay home if possible.
posted by kinddieserzeit at 4:53 AM on March 15, 2015 [1 favorite]

In terms of going to the doctor:
I wouldn't bother for a cold unless your symptoms don't start to improve after a few days to a week.

For an illness that involves digestive issues, there is a guideline for when you should see a doctor. It escapes me now but I feel like if you've been throwing up for over 24-48 hours, it's time to see someone.

If you have chest pain, difficulty breathing, blood in the urine, or stool that resembles coffee grinds, medical attention is needed ASAP.
posted by kinddieserzeit at 4:58 AM on March 15, 2015

1. This is partly what the physical is for. Yes, it's only once a year but you can get baseline information about your health. You can also share your concerns with your doctor and depending on his or her qualities he or she may really help. For quirky reasons of my own I can't locate pain in front of other people or assign values to a pain scale except in very extreme pain (I stop feeling it) but my doctor has worked with me on that, as have some really excellent ER staff over the years. Journaling can help too - note your symptoms and your mood and any events like conflicts. This is how I found out I get stress headaches which would seem normal but like I said, quirky blind spots.

Also, you probably know this but non-ER doctors see people relatively often who don't have anything serious and that is okay. You don't want to be in every few weeks maybe but it is not a moral failing to go in from time to time with symptoms and come out with a clean bill of health. Dr. Google only helps so much. The nurse line suggestion is great.

Finally, stress is actually a health issue, especially if it is resulting in physical symptoms. I don't know if you are addressing it but you have my ok to research physical things you can do to mitigate it, like yoga. Or watching hilarious comedies. Then you kind of have the equivalent of "take two aspirin" -- if you do the mitigating thing and nothing calms down you have more information.

I say all this as someone who used to not experience many physical symptoms (like, I would feel a little uncomfortable in my throat and it would be a raging strep infection) and then hit a breaking point where a few times my fight or flight response resulted in extreme symptoms. It's hard but you can do this and matter-of-factly asking your doctor "how will I know if I should come back!" etc. can become a habit.

2. You've gotten good advice, but from the snotty parenting trenches I will say people also have really different cultures about it. In general I think the advice that if you feel up to it and are not "super goopey" is sound; also that you wait 24 hrs after a stomach flu, wash your hands, and in our family we usually stay home with a fever and the day after, just like daycare rules.
posted by warriorqueen at 5:09 AM on March 15, 2015 [1 favorite]

Every time that you have a worry-thought, pause for a moment and ask yourself:

1) Is this my own thought or something from my parents?
2) Am I using this thought as an excuse to get out of something that I do not feel comfortable doing?
3) Apart from feeling this way, would I rather stay home or go?

Most of what you are dealing with is radio noise from childhood. My mom will still guilt me into staying away from people if I might be sick. The long and the short of it is, colds happen. They are not your fault. Only stay home if you feel really bad or if you have something serious enough that it could send someone to the hospital (flu, stomach virus, chicken pox, etc.). The people who are immune compromised enough to die from a cold are taking their own precautions and you are not a threat to them.
posted by myselfasme at 6:54 AM on March 15, 2015 [3 favorites]

For the first thing, I think the therapy is really the main thing that will help you here. Does it help at all to realize that worrying about your health just really does you no good? Your friend's illness and death must have been very scary for you, but she is not you, and although terrifyingly random things can happen, worrying about cancer doesn't do you any more good than worrying about being killed in a terrorist attack or something. If anything, the worry actually makes you less healthy, due to the stress it causes.

I really like the idea of starting with "things you need to go to the emergency room for" and working back from there.

For the second, social thing, do you feel like you could step up to a "tiered" kind of system? Like, I probably work something like this:

1) Stay home entirely: anything where it's difficult for me to function (high fever, diarrhea/vomiting, exhaustion, etc.), anything I have reason to believe is highly contagious (e.g. measles, god forbid).

2) Might go to work but probably wouldn't go to a social event, and if I had to go out would limit my contact with others - no hand-shaking, no hugs, and frequent hand-washing: moderately frequent sneezing, coughing, or nose-blowing; feeling tired and gross.

3) Would probably go to social events but would avoid handshakes and hugs and would wash hands frequently: runny nose, mild coughing.

and D) Might go out if I felt OK but would avoid physical contact and any kind of food prep or serving: a few days after having gastrointestinal issues.
posted by mskyle at 6:56 AM on March 15, 2015

I cancel going to parties when sick all the time. Mostly, it has to do with my strongly held belief that rest is the best remedy against a cold or flu.

I would suggest you use the same criteria: if you're feeling tired and in need of rest, stay home. If you feel energetic enough to attend the social event, go.

As for work: you are most contagious at the onset of the cold. It also happens to be the time when your immune system will benefit the most from some rest. So, if possible, stay home for the first day or two of the cold.
posted by Milau at 7:02 AM on March 15, 2015 [2 favorites]

It sounds to me like you are a hypochondriac. I suggest finding a professional who you can talk to about this experience with disease if it's causing you significant anxiety.

I think it is courteous not to come into work when you have a bad cough or sore throat, but it's not a moral failing if you do. In some work places, it might seem like a selfish thing to do to come in with a bad cold, since the perception is that you could infect others. Parents seem more sensitive to this than others.

But I don't think this is a very rational belief. A common cold virus is going to be so easy to pick up that you're no more likely to catch it working next to someone with visible symptoms than you are when hanging around in a public place with lots of strangers.
posted by deathpanels at 10:44 AM on March 15, 2015 [1 favorite]

My parent had cancer at a very young age so I always thought I was going to get it and then as I got older and didn't worry so much about my weight I gained a few pounds and my friend, also not thin, said, as we were eating ice cream, "we may be fat but at least we know we don't have cancer." Her logic being that if we did have cancer we would first know it because we would lose weight and start wasting away. Now, I'm sure not all cancers begin that way but the joke has really helped me. Whenever the thought pops in my head that I might have cancer (happens at least once a week) I say to myself "I can't have cancer - I'm fat!" And then I laugh.
posted by cda at 6:02 PM on March 15, 2015

IANYD, but I'm an emergency department doctor. It's my opinion that if you have a symptom that's bothering you, it's pretty much ALWAYS worth talking to a doctor/health professional about. Yes, ALWAYS, but the catch is that you need to know what timeframe and setting you need to talk to that health professional in.

Perhaps it would be helpful if I gave an abbreviated list of examples of different types of symptoms and the timeframes/settings in which you should consider seeking medical care for them.

Emergency - Immediate/ASAP - Emergency Department - cardiac arrest, confusion/altered mental status, chest pain, shortness of breath, syncope (passing out), abdominal/pelvic pain, palpitations, serious injury (heavy bleeding, bone sticking out of your body, numbness or inability to move an extremity, or serious injury mechanism plus another symptom listed here), weakness, seizure, severe headache, drug overdose with some of the symptoms listed here, suicidal thoughts, hallucinations (visual or auditory), nausea and vomiting with inability to keep down fluids/medications, allergic reaction (hives, swelling of mouth or throat).

Urgent - Within 12-72 hours - Urgent Care or Primary Care sick appointment, call nurse help line - sore throat, upper respiratory infection/cold, cough, acute diarrhea or constipation, back pain, extremity injury without any other complicating factor, laceration, rash, vaginal or penile discharge, pain with urination.

Generally non urgent - Weeks to months - Discuss with primary care at a regular routine visit - Sleep issues, dietary concerns, blood pressure checks, weight loss or gain, mental health concerns, libido issues, chronic mild pains (headache, muscle aches, etc), chronic mild GI concerns, preventative health issues (vaccines, screening tests), lumps/bumps or other non-painful/nonitchy skin issues, prescription refill.

As for your question about going to social gatherings, as a physician I very much appreciate you trying not to give your illnesses to anyone else. If it's a mild cold, I wouldn't worry too much about going out unless you are going to visit a baby or otherwise immune system compromised person, as long as you cover your mouth for any sneezes and wash your hands frequently. Anything more than that, I urge you to bow out.

If your friend is giving you a hard time about missing a party because you were sick, consider that the problem may be the friend, not you.
posted by treehorn+bunny at 6:13 AM on March 16, 2015 [4 favorites]

One good rule of thumb I would consider:

Can I treat this symptom effectively with medications available over the counter at the pharmacy?

If you can treat the symptom effectively with an over the counter medication, in many cases that eliminates the possibility that the issue is an emergency, and potentially eliminates the need for any sort of urgent healthcare visit.

If you can't treat the symptom effectively with over the counter meds (example: the pain is too severe and is not relieved, you've treated symptoms of an infection but may need antibiotics, you can't take over the counter meds because you are vomiting too much) - you likely need to see someone who can determine if and what prescription medication you need on an urgent or emergent basis.
posted by treehorn+bunny at 6:21 AM on March 16, 2015

For seeing the doctor, I would see if your health insurance has a nurse advice line (it might be on the back of your insurance card or on their website, if they do). I have called this line on many occasions, and gotten excellent advice on the range of "Urgent Care, now!" to "Call your doctor and tell them you need an appointment in the next couple of days" to "You should be ok with X over-the-counter, but if things get worse go in to see the doctor." It might help you to get a professional opinion on what to do. I know I'm always reluctant to go in until things are really bad because I don't want to "waste" the doctor's time or I feel like I'm being silly/a hypochondriac, but thenoften the nurse will say -- hey, this actually sounds serious and you should come in! Backed by that assessment, I feel much less sensitive about going in and taking up the doctor's time, because hey -- a medical professional told me to!

For social engagements, I would let your own energy levels and ability to go out be your guide. If you're exhausted, running to the bathroom every 10 minutes, etc. YOU probably don't want to be out and about, and if you have the sick days to use, take care of yourself and use them, and don't feel guilty about missing social stuff. If you feel mostly ok but you're sneezing or have a sore throat or a headache that's not debilitating, I'd say go for it. I do agree with the idea of not shaking hands/hugging, and I do that as well -- I just say "Hey, I've got a bug and I don't want to infect you!" I don't think I've ever had someone react poorly to this, and they usually seem grateful. If you're going to be hanging out with an infant or someone with a supressed immune system, check first and let that person's comfort be your guide.
posted by rainbowbrite at 8:37 AM on March 16, 2015

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