As soon as I stepped into the exam room, I could smell it. That distinctive odor, called "feet" by lay people. Tinea pedis. Fungal infection of the feet. You know what I'm talking about. We all know (or are) someone with "stinky feet". These are the people that get stuff thrown at them if they take their shoes off in the car, who have to leave their tennies outside the back door, who balk at the request to remove their footwear in Japanese restaurants or sensitive homes.
There was a guy on the exam table, fully dressed, shoes firmly on feet. He was here for a sore throat.
Now, here's the dilemma. Do I address the foot issue or not?
A confounding factor is the structure and flow of the Walk In clinic, where I was working that day. We have several exam rooms, several practitioners, and a steady flow of patients. The practitioners don't have assigned rooms. Once I finish in one exam room, I move on to the next waiting patient, whatever room they're in. We just go along, taking turns and going to where we're needed next.
I had no idea who was in the room before this guy, nor how long he had been waiting there. Maybe it was the patient before him who had stunk up the place, and my patient's feet were clean as a whistle. Maybe I was making a false accusation, and would just anger the patient and make the clinic look less than pristine by calling attention to the choking fog.
Setting that aside as the lame excuse it is, the real question remains. Assume that I know that this pharyngitic person (big word for sore throat) was the odorous culprit. What do I do? He didn't ask to have his "foot problem" addressed. He's here for a sore throat, feels miserable, wants to get help and get back to bed. Should I say, "By the way, I'm noticing a distinctive, um, odor in the room, reminds me of limberger cheese..." Just kidding. I'd be more professional, of course! I would!
But should I? Do people expect their docs to address every health issue at every visit? Or do they want us to stick to the subject at hand, particularly in an urgent care setting? Would I be rude to mention someone's terrible acne, or remiss not to, when they're here for a sprained ankle?
As a Family Doctor, trained to view the patient as a whole organism, I tend to err, if you will, on the side of addressing rather than avoiding. Certainly if the "other issue" contributes to the problem at hand (like smoking when they have a respiratory infection) I feel compelled to mention it. It's bad medical practice if I don't. But something like smelly feet with a cold? I can't concoct a connection there, so addressing it is in the realm of "unrelated other".
What should I have done? What would you do if you were me? What would you want me to do if you were the patient?