My cure for Sunday syndrome

September 1, 2006

Just say No when friends ask for a quick diagnosis at the supermarket or golf course.

A few years ago, my wife and I were entertaining friends. It was obvious that Ed had a bothersome cough. His wife jokingly grumbled that it was keeping her awake at night, and asked if I had some magic remedy. I did have some samples in the house, so I gave Ed a few bottles of an innocuous cough syrup. Fortunately, the medicine didn't suppress his cough.

A week later, he went to see his own doctor, who initiated tests that led to the discovery of a tumor in Ed's throat. Luckily, the lesion proved benign and was successfully removed. But that experience made me realize I hadn't done my friend a great favor by trying to treat his symptoms so casually. I had succumbed to what I call the "Sunday syndrome."

Not long ago, one of my own patients came to my office and showed me the antibiotic another doctor had prescribed for what she termed "an infected rash" on her shoulder. Although she had taken the pills, the lesion had become worse. I examined her shoulder and informed her that her rash was a herpes zoster.

Bill, another patient of mine, recently became a victim of the same affliction. Bill has a golfing buddy who happens to be a doctor. One day out on the golf course, Bill mentioned to him that he was developing symptoms similar to those associated with a prostate infection he'd had the year before. Without bothering to ask if Bill was taking any other medication, the doctor was kind enough to give him samples of an antibiotic to tide him over until he could get an appointment with me. Bill didn't mention that he was also taking medication for his diabetes. The drug interaction put Bill in the ED with a severe hypoglycemic episode.

As these examples illustrate, the Sunday syndrome, however well-intentioned, frequently has unfortunate and even dangerous results. By the very nature of our calling, we doctors are often tempted to do such "favors" for friends: making a spot diagnosis, giving some off-the-cuff advice. But while our motives may be commendable, succumbing to such temptation can be hazardous to our friends, our reputations, and our liability insurance. For ultimately we are judged not by our motives or our acts, but by their outcomes.

We have the best chance of achieving good outcomes if we confine our practice to the office or hospital, where the patient can undress and we have access to X-ray and ECG machines, instruments, and lab tests. In those settings, we and the patient will take a case more seriously than we might at, say, a backyard barbecue.