After 20 years in practice I’d never seen one of these in my career. Until that day. It’s called a quinsy. Essentially an abscess deep in the throat. Not really surprising because according to a recent review:
Most patients with quinsy develop the condition rapidly, and many do not present with a respiratory tract infection to their GP first. BJGP
The incidence is estimated to range from 10-41 cases per 100,000 per year. It’s unusual to see a case in practice. Given Australia’s 23 million people you’d expect an incidence of about 2,300 cases per year nationwide. Similarly I consulted a young child with nephrotic syndrome, similar incidence (3.6 per 100,000). Both cases were referred to hospital as emergencies. The odds of seeing one of these is in the same order of magnitude as being struck by lightening in your lifetime.
On the other hand in the same week I saw several people with:
- An upper respiratory tract infection (the commonest diagnosis in primary care),
- Tinea pedis (prevalence 2.9%),
- Acute bacterial conjunctivitis (13 to 14 cases per 1000 people each year),
- Otitis externa (8.1 visits per 1,000 population),
- Pityriasis rosea (172.2 per 100,000 per year) and
- Impetigo (annual incidence 1-3%) .
I also saw a victim of domestic violence:
Just under half a million Australian women reported that they had experienced physical or sexual violence or sexual assault in the past 12 months. Domestic violence prevention centre.
And a drug seeker:
Australian GPs write more than 15 million prescriptions per year for drugs known to be misused, with the main prescription drugs misused currently being narcotic analgesics and benzodiazepines, as well as stimulants, barbiturates and other sedative–hypnotic agents. Martyres et al
So apart from quinsy and nephrotic syndrome (both of which I recognised) I spent most of my week managing conditions that didn’t need to be referred to specialists. And yet the people who were offered reassurance or simple and effective treatment for their ailments were immensely grateful. Every day general practitioners provide this service to the community. They save lives by identifying people who need urgent care but much more than that they make the lives of the community so much more tolerable. There is no such thing as ‘minor illness’.
The last word has to be on pityriasis rosea:
I finally found out what the rashes on my back, arms, torso, and now my foot are. I have herolds patch too. I hate it! I can’t stop scratching. It took 1 hospital visit and a trip to my doctor to find out what this thing was. The doctor at the hospital thought the big round patch was a ringworm and he thought all the other small rashes that had just appeared was scabies. I was terrified..did some research on scabies and tried to treat that myself. Then I decided to just go to my doctor and he told me it wasn’t scabies…and showed me a picture of hereld’s patch. He knew what it was right off the bat. I guess there is no cure for it and it just goes away by itself. I just wish I could take something so I can stop scratching. SkinCell forum
Picture by Col.Sanders