A doctor shares what happens when patients with poor hygiene come in.

This is Maureen Boehm’s answer to the question ‘What does a doctor do when a patient comes in for an exam and smells really bad?’ on Quora.

Dealing with foul odours is part of the job. There are a lot of diseases that don’t smell like roses. You get used to it. Never, ever, ever embarrass a patient about that or anything else. They are in a vulnerable position. They have to reveal sometimes uncomfortable information to someone that they perceive is in a position of authority. It’s not easy. I don’t make it harder.

If a patient has a hygiene problem, this can be a big clue to the physician. Perhaps their poor self-care is due to dementia or mental illness. That requires some gentle probing question about what’s really up.

If an older person came in and it was evident that they were not remembering to bathe, perhaps they are not remembering to eat or takes their medications. Maybe they are no longer safe in their home. That is a big red flag that tells me that it’s time to call in the family and the social workers for further evaluation and some tough decisions.

I don’t ever think ““You smell bad”. I think “WHY do you smell bad?”

I do have to admit that once, while I was placing a femoral line (it’s like an IV in the groin) for emergency dialysis, that the poor lady had lice that crawled out of her pubic hair and up my arm. I was so intent on getting the line placed that I didn’t notice until I had quite a few of them on me. When I looked down and saw them I let out a yip and jumped back. I just wasn’t expecting that. I still feel badly about it. I know I probably made her feel badly. She looked down at the floor and told me that she could only afford a place that was infested with lice. She just could not get rid of them. My heart just broke.

Another time, I was seeing a very pleasantly demented man. As we talked, a bed bug crawled across his face. I stifled a shudder. He chatted on happily, seemingly unaware of it. I carefully removed the bug from his eyelid with a tissue. Another appeared from out of his hairline. A quick exam revealed that he was crawling with them. We had to take action to have his apartment and our office treated for bed bugs.

Bottom line, it’s not about me. Nobody wants to smell or have bugs. Sometimes that is simply how it is. We do the best we can. I’m here to help. That’s my job.

This post originally appeared on Quora and was republished here with full permission. 

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