Dear patient, you stink! – DocCheck

Smelly feet, sweaty armpits, bad breath – some patients expect a lot from us doctors. Why do they stink? There can be various reasons for this.

In our everyday medical lives, we like to be confronted with all sorts of things that our non-medical friends or family members find disgusting. For example, a patient recently showed me a photograph of the contents of his toilet bowl. I thought it was great. And I mean that seriously, because even when I asked myself about the appearance and nature of the excretion (“Was the stool thin as water or rather mushy?”, “What was the color? Black like tar or rather dark brown?”, “Did the chair shine?”, “Foamy?”, “With bits?”) can usually make a good picture, a photo makes my work a lot easier.

A lot is normal

Also, I don’t find it disgusting at all when I examine patients and they sweat. People often apologize for this, but sweating is a normal bodily function. We all do it to a greater or lesser degree, and it’s just toasty under the arms or in the groin, so the body oozes some fluids.

Feet are not my favorite part of the body, but usually you can’t do anything about the characteristic foot odor. Many people subtly stink on their feet, even if they have washed them beforehand. In addition there is nail fungus, skin fungus, warts, cracks, Chicken eyes and plenty of calluses that adorn our feet and can be removed with more or less complex care. How calloused the feet are is often due to the constitution.

It doesn’t bother me at all and I think I would be in the wrong job if I had problems with it.

Poor hygiene: Now it’s getting disgusting

Now comes the big but: What I have little understanding for is the absolutely non-existent body hygiene of young and healthy people. And I don’t mean the very individual idea of ​​​​perfume, fashion of underwear or state of depilation. Where and how people wear their hair, on their heads, under their arms or quite intimately, whether there is smooth skin or curls or braids, that is personal hair fashion.

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I remember a young man who was with me in one of the corona waves. He looked a bit sleepy, his hair stood up uncombed and he sniffed into his face mask, which led a wet trickle from nose to mouth. Of the COVID-19 rapid test was negative, he seemed to have a bad cold and I asked him to put the mask aside for a moment to inspect his throat.

Case Study: Bad breath

The air that came towards me and which I even smelled through my FFP2 mask took my breath away. The teeth were greasy and showed brown edges. That was not bad breath, which one likes to have with inflammation in the throat area, because this smells different. Before Corona, when you went to the doctor without mouth and nose protection, you could sometimes already do the so-called The stench from the mouth get a clue as to what the problem of the person sitting in front of was.

If it smells sweet and purulent, then it speaks for one inflammation of the tonsils or the side strands. Paradontose or dental problems smell biting, musty. The smell for stomach problems and heartburn is rather angry, and Diabetic with severely elevated blood sugar or people who have not eaten for a long time (e.g. children with gastrointestinal infections) smell of old fruit or nail polish. The young man just smelled like “I haven’t brushed my teeth for a long time”.

From cat washing to excessive hygiene

Isn’t that the least bit of hygiene you should show? You get up and brush the morning smell from your teeth, wash where you need to and brush your hair. cat wash. It’s understandable that when you’re ill you don’t hop in the shower and put on your favorite perfume. This is not even necessary for going into practice.

Sometimes it even makes sense not to over-groom yourself when you go to the doctor. Because as a general practitioner, I assess the overall condition of my patients. In addition, as family doctors, we often know our patients for a long time and simply know whether they were simply too ill for the big laundry on the day of the visit.

However, excessive hygiene can also have a cumbersome effect on the examination. When patients don’t want to undress because they haven’t shaved, or just got back from work and feel sweaty. Every now and then I have old gentlemen who first have to awkwardly peel off their skirts, lace bodies or undershirts and shirts (with tank tops) before I can examine them. Because in the past (and I’ve learned that too), you didn’t leave the house in sweatpants or unwashed.

But not everyone is to blame

Now I have one more objection: Not everyone can wash themselves. What is (actually) normal for us (reasonably) young and healthy people can be a big hurdle for older people or for the sick. Many old people can no longer shower or bathe by themselves and their hair is only washed once a week. Because it just doesn’t work on its own anymore. Already a Hüftarthrose can be to blame that the toenails are too long. Or the big pregnancy belly.

If patients look generally neglected and unkempt, one must think of a mental illness. who under Depression suffers, sometimes simply cannot take a shower because all activities are tedious and a burden. Another example from the psychiatric spectrum: With a schizophrenia Everyday things like eating and personal hygiene are neglected. You have to be careful not to judge these patients prematurely. It’s not your fault!

Incidentally, as a doctor, you become hardened during the nursing internship of the basic course: you wash patient after patient, brush teeth, prostheses and genital areas, remove feces from folds, fingernails and bed linen and become humble in the face of life.

We can all find ourselves dependent on other people for personal hygiene. We don’t even have to be very old for that when life decides to make you dependent on care. As is usually the case in life: normal is simply best.

Image source: Richárd Ecsedi, Unsplash

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