Many patients come to me saying, “Hey doc, I think I’ve got strep. I’ve got a sore throat and have some white spots on my throat.”

So, do they have strep?

Based on the current information that they gave me here’s the statistical likelihood based on age.

• 3-14 years old: 11-17% chance of strep
• 15-44 years old: 5-10% chance of strep
• >45 years old: 1-2.5% chance of strep

Surprised?

So, when that 47 year old man says that they believe they need antibiotics for a sore throat, what am I to do? He has a 97.5% chance that this is NOT strep!

… but it could be.

The best way to be sure is to swab and test it.

In the online world, we use a calculator called a Centor Score to give us an idea of the risk for strep. It uses things like age, fever, swollen tonsils, etc, and can be helpful for making a diagnosis.

It’s important to realize, however, that even if EVERYTHING looks like strep and you or your child scores 5/5 on the Centor Score, the risk of strep is still only 51-53%!

It’s a flip-of-the-coin!

I learned this in my training and especially in the Urgent Care. Every other person coming in to the clinic is complaining of a sore throat. Even if they all LOOK like they have strep, most of them do not.

The point here is that no doctor, no matter how good they are, can simply ask questions and do an exam and accurately diagnose strep 100% of the time. It’s impossible.

Because of this, it particularly irks me when patients will come to me and say that they got put on antibiotics for strep…. (and usually they are still having symptoms).

“Did they swab you?” I ask.

“No, they just looked at it and said it was strep.”

(ugh)

I’ve looked at and swabbed a thousand throats. I KNOW you can’t “just look at it.” There are other causes for sore throat with white spots. And if you’re my family, friend, or patient, I’m not gonna put you on a strong antibiotic with a list of side effects a page long on just a 50% chance that it might be the right treatment.

Patients deserve better.

In the next post I’ll talk a little bit more about testing and treating sore throat.