FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

DOCTOR'S USE OF OTOSCOPE NOT LIKELY TO SPREAD INFECTION

Question: I had a bad ear infection and had to go to an ear specialist. He examined the sick ear with the searchlight with the black cone on it. When he moved over to check my good ear, he was going to use the same black cone. I mentioned that I didn't want the infection transferred to my good ear, so he replaced the cone. Needless to say, his attitude changed after this, and he brusquely concluded my exam.

Wasn't I right in correcting him? Wouldn't using the same black cone spread the infection to my good ear?

Answer: Your question brings up three very good topics. One is the obvious part about spreading infection, the second is about patient rights, and the third is about interpersonal communication styles. I'll address each of these separately, and I'll tackle the "spreading infection" question first.

Ear infections are classified as being one of three types: Outer, middle or inner. Outer ear infections occur within the skin covering of the ear and ear canal down to the eardrum. This type of infection is quite common and often is identified by the more familiar term "swimmer's ear." In theory, it would be possible to spread this type of infection from one ear to the other, although it isn't very likely.

If the region from the eardrum to the deeper area called the "inner ear" is affected, it's called a middle ear infection. This type is also quite common, particularly in children. When someone says "I have an ear infection," they usually have a middle ear infection. Inner ear infections involve only the deepest structures in the ear and are associated with dizziness and hearing loss. Fortunately, neither middle or inner ear infections can be spread from one ear to the other by an ear exam.

It is quite likely that the ear problem you had was a middle ear infection and, therefore, could not have been spread by the "black cone" of the doctor's otoscope, the medical term for the "searchlight."

From my perspective, the most important part of your question is about patients' rights. You have the right to question your physician about your care. Certainly you can ask him or her to change the disposable tip of the otoscope! You should be an active participant in all of your health care. You aren't the sore ear in exam room 3, are you? Of course not. You are an individual with a complex group of symptoms including a sore ear interwoven with your hopes, your fears, and your personal and cultural values. Interact with your physician, don't just be a sore ear. It is your right!

Another important issue is interpersonal communication styles. We don't all communicate in the same way. Using the same words, but with different vocal inflection, facial expressions and body gestures can have dramatically different meanings. Your simple request to change the otoscope speculum may have been interpreted by the doctor as implying that you know more about ears than he does and you know how self-important we physicians can be at times. He responded by being abrupt and unfriendly.

You experienced a failure to clearly communicate. Your request was based on a legitimate concern about transferring infection to your good ear. The doctor interpreted it as an assault against his integrity. Communication with others is never easy, is it? If you continue to have the same kinds of problems with this doctor, it's probably time to find a new doctor - one whose style of communication more closely fits yours.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.