Positive Burger King Sign

Sometimes being a good doctor means being a detective. Usually it’s question-and-answer detective work. A good history will give me the patient’s diagnosis in many cases. Sometimes there are other clues…

I walked into the exam room of a 7 year old little boy whose parents had brought him to the ER for 3 days of vomiting and diarrhea. He wasn’t febrile and his vital signs were stable. He sat there happily playing with a familiar looking yellow ball. "He’s been throwing up for two days straight," said his mother, "and having diarrhea too." The kid looked pretty happy for someone who had supposedly been puking his guts out, and he didn’t look dehydrated either.

I knew being a mom would help me with pediatric patients. Sure enough, the yellow ball the patient had was the same yellow ball Cole threw around the back seat on our recent road trip after receiving it in his Drive-Thru Burger King Happy meal.

"Is that a Burger King Happy meal toy?" I asked the kid.

"Yup!"

"When did you eat Burger King?"

"Yesterday!"

"Did you eat it all?"

"Yup!"

"Did you throw it up?"

"Nope!"

I looked at the Mom for confirmation. "He kept down a Burger King Happy Meal yesterday?"

"Yes," said mom.

Where I trained there was a McDonald’s in the hospital lobby (to keep the Cardiac Cath lab in business, we always joked). This was often problematic in the ER. I can’t tell you how many times I looked over at a poor patient who was being kept NPO ("nothing per oral") and saw family members torturing them by eating a Quarter Pounder right in front of them. Even worse, you wouldn’t believe how many times a patient who came in with "Belly Pain" would be sitting there munching on greasy french fries. The docs training us called it the "Positive McDonald’s Sign": If you were well enough to sit in the ER and scarf down McDonald’s you probably didn’t need to be in the ER.

Well, it didn’t take the aroma of Whopper Junior in my ER to clue in Doctor Mom, detective… all I needed was the little yellow ball. This kid had a Positive Burger King Sign. I reassured the parents, and home he went.