Blog | Thursday, January 29, 2015

Did President Obama receive high-value care for his sore throat?


President Obama had a direct laryngoscopy and then a CT scan for a persistent sore throat. As a physician who has studied acute pharyngitis for 35 years, I had to carefully think about his complaint and the decisions that his physicians made.

First, his “sore throat” was not acute pharyngitis. Guidelines and expert recommendations on acute pharyngitis diagnosis and management only apply to patients who have a brief (5 day or less) acute illness characterized primarily by a sore throat. Thus, we should not expect that the standard approach to pharyngitis would apply.

Second, we only have a label: “sore throat”. Without taking a careful history, we cannot really criticize his physicians. The term sore throat could mean several different presentations. Did he have neck soreness or throat soreness? Was it continuous? What made it worse? What other symptoms did he have? Did the pain radiate?

We are told that he had posterior pharyngitis. Posterior pharyngitis is the classic finding that patients develop with chronic GERD. Once his physician found posterior pharyngitis, then one could make an argument that he should have a trial of a PPI, and then see if his symptoms resolve.

Did he have red flags that led the physician to order a CT scan? We do not know. Some have argued that his smoking history made laryngeal cancer a possibility.

I really want to be critical – this is a ranting blog. But I do not know, primarily because I did not take the history and examine the patient! The CT scan did not seem like usual care. One wonders whether, like many famous people, he received too much investigation. But none of us really know.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.