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Clinical Crossroads | Clinician's Corner

A 65-Year-Old Woman With Acute Cough Illness and an Important Engagement

Ralph Gonzales, MD, MSPH, Discussant
JAMA. 2003;289(20):2701-2708. doi:10.1001/jama.289.20.2701.
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DR REYNOLDS: Mrs W is a 65-year-old woman who recently switched to a commercial Medicare insurance plan and who presents for an urgent visit with symptoms of an upper respiratory tract infection [URI]. She works in the family business and lives with her husband; they have 3 grown children.

Because her new insurance plan did not cover her former physician, Mrs W made an appointment with a new physician in a large, university-affiliated group practice. Before her initial appointment, however, she became ill and requested an urgent visit. Seen the same day, she complained of 24 hours of sore throat, cough occasionally productive of small amounts of green sputum, and subjective fevers and chills. She also had mild shortness of breath, but no pleuritic chest pain. She had not taken her temperature at home. She denied ear pain, sinus pressure, headache, orthopnea, or paroxysmal nocturnal dyspnea. She had been treating herself with fluids and acetaminophen. Her husband had similar symptoms the previous week and had been empirically treated with levofloxacin. Mrs W requested antibiotics because she hoped to feel well for a planned family party for her birthday, and because she wanted to avoid infecting her family, especially her pregnant daughter.

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