There is a dictum in Medicine: “Common things happen commonly”. Doctors in training hear it all the time.

It seems obvious, and that’s why doctors usually opt for the commonest diagnosis topping the list of possibilities when presented with any particular patient. Call it an educated guess. A gambler would call it a good bet.

Funnily enough, in my experience, in patients who go and look up their symptoms on the internet, for some reason they always believe they have the most awful, rarest condition, rather than the commonest! Talk about fancying the outsider!

However, just because a condition doesn’t happen often shouldn’t mean it should not be considered a possibility. So here’s the trouble with being a doctor. You see the same old condition, day in, day out. Another one walks in the door- same as all the others. Almost boring, some would say. But the condition is very real to the patient – and pretty miserable. They get a few understanding words from their Doc (hopefully!), and a routine prescription and off they go. But what if it is not quite what meets the eye, not quite what it seems? Is it feasible to carry out every investigation/test known to man on every patient who has a routine condition, such as tonsillitis or the common viral cold? Of course not. Unfortunately, sometimes even these common, routine diseases can develop complications. And sometimes very quickly indeed.

This week, a 15yr old boy was admitted to my hospital with such a problem. He had a nasty cold and developed facial pain, headache and temperature. So what? Give him some antibiotics and he’ll be fine! Right in most cases, but not his. That’s exactly what happened but he developed such severe sinusitis that the pus in his frontal (forehead) sinuses ruptured through into the brain cavity – hence the headache. The CT scan which was done showed air in the cranial cavity So he underwent emergency surgery on a Sunday and a lot of pus was drained from his maxillary (Cheek) sinus. Unfortunately, he continued to spike temperatures and over the next couple of days, the headache never abated. A colleague of mine asked me to take a look at him as he was not really doing as well as hoped.

I took him to theatre (that’s what we call the OR in Britain!) yesterday and re-explored his nasal cavities endoscopically. First, I had to carry out a septoplasty to create enough access and then we drilled into the frontal sinus where we found a load of pus under pressure. It oozed out like toothpaste from a tube when it was released.

I am please to say that today, he was transformed. His temperature was gone as was the headache. He had virtually no bleeding from the nose despite no nasal packing being used, even though his surgery was actually quite extensive. His anxious parents are delighted. They understood the potential seriousness of the situation and were understandably extremely worried- especially since the initial op had clearly not resolved the problem. Anyway, they have their boy back and all’s fine.

So where’s the lesson. They were angry at their own family doctor for not diagnosing the problem. But how can you be? The family doctor sees dozens of people with ordinary colds every week. This was just another one of them. He did the right thing, given the limited amount of information available to him. I think the lesson is: if things are getting steadily worse, despite treatment, don’t sit back and accept it. Seek another opinion possibly from the same doctor (with benefit if continuity) or even another one. Things change and the signs may be different the second time. That’s why this boy didn’t loose his eyesight, or end up brain-damaged or dead: simply because his folks kept bringing him back until someone did a scan, and then the answer stuck out, like a sore thumb. Nonetheless, I don’t think you can blame the family doctor for not doing a CT scan. After all, you can’t CT scan everyone with a viral cold, can you?