Author Affiliation: Dr Gonzales is Associate Professor of Medicine, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco.
Clinical Crossroads Section Editor: Margaret A. Winker, MD, Deputy Editor.
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.
Gonzales R. A 65-Year-Old Woman With Acute Cough Illness and an Important Engagement. JAMA. 2003;289(20):2701-2708. doi:10.1001/jama.289.20.2701