Q. I work as a health writer and want to know how to tell if a clinician has made the right judgement. I've had many episodes where the doctors give a diagnosis as "viral" when it isn't. What can consumers ask their clinician as to why they've made their diagnosis? How does a clinician make the choice of whether something is bacterial or viral?

A. This is a question that physicians face daily in medical practice, evaluating patients with an acute infectious illness and trying to determine the cause. Much of this decision-making process depends on experience and clinical judgement. In many situations laboratory tests are not very helpful in this regard. An example might be a patient with a sore throat, certainly a common problem in the winter. If the symptoms are mild, and no fever is present, the decision might be to monitor the patient for the next few days. Lab work could include a throat culture to look for Strep throat, a bacterial infection needing antibiotics, and possiblly a blood count.

Severity is often a clue; sicker patients are often more suspicious for having a bacterial infection, but certain viruses can cause significant illness as well. We have the dilemma of trying to use antibiotics when appropriate, and to hold off when they are not likely to be helpful.

http://www.familydoctor.org/flowcharts/503.html

http://www.familydoctor.org/healthfacts/073/

http://www.familydoctor.org/handouts/680.html.

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