Linda was a 24-year-old woman who presented to the ER complaining of vulvar irritation she noticed while having sex the prior night after a long period of abstinence. Interestingly, she'd seen her gynecologist a few hours before, but Mr. Magoo (see box below)—or should I call him Dr. Magoo?—couldn't find anything wrong. Linda knew that something was amiss, so she came to the ER.

The second I looked at Linda's vulva, I wondered how Dr. Magoo could have missed something so obvious. The patient's vulva was peppered by several growths that were a textbook case of genital warts, but the rest of the examination was unremarkable.

I removed my gloves and sat next to Linda as I explained what I'd found along with its treatment and somewhat dismal prognosis. Tears welled up in Linda's eyes, and then she explained her dilemma. Should she tell her boyfriend, since he may have contracted an infection? Or should she wait to see if he developed warts? She did not want to tell him needlessly because she was afraid he might dump her. I wasn't too worried about that. Linda was indescribably pretty, and most guys would not be in a hurry to let her go, warts or no warts.

Laypeople probably assume that doctors are told how to handle such issues during medical school, but med school professors are too busy lecturing about rare diseases to have enough time to give us advice on the best way to handle these common quandaries. So, guided by our common sense, we wing it.

I held Linda's hand as her tears flowed more freely. I told her that I thought she should tell her boyfriend. Since I had no way of knowing if he would remain faithful to her, I was concerned about the possibility of him unknowingly spreading genital warts to other women. If he were apprised of the potential infection, he would not risk infecting anyone else. At least, he would not do that if he were moral.

The next day I received a phone call from Dr. Magoo, who was piqued because he thought I gave Linda too rosy of a prognosis. He told me that he'd reexamined her and—surprise!—confirmed that she indeed had genital warts, for which he planned to treat her. However, he wanted her to have a very low expectation of the prognosis so that she wouldn't be disappointed when Magoo's treatment failed.

I was not about to let myself be pressured by such an incompetent buffoon. There are many difficult things in medicine, but knowing that a vulva covered with genital warts is not a normal vulva is surely one of the least challenging tasks facing a doctor. And what self-respecting gynecologist needs an ER doctor to tell him that his patient has genital warts? If Magoo was challenged by the simple task of recognizing warts, I wondered how skilled he would be in treating them? Probably not very, I thought. No wonder why he wanted Linda to believe that she would have warts no matter what he did!

While there may be some miraculous permanent cure at the time you read this, when I saw Linda there was no known way to definitely rid the body of the virus that causes warts. Therefore, the mainstay of treatment was to cauterize or otherwise remove the initial warts and whatever warts might subsequently appear. However, in diseases such as warts in which there is long-term persistence of a virus in the body, few doctors counsel their patients on things they can do to minimize the risk of recurrence. The conceptual mistake these doctors make is to assume that a patient's immunity is fixed. That is incorrect. If there were a medical device that could gauge immunity the way we measure temperature or blood sugar, you would see that your immunity is constantly changing in response to many factors. When it dips, you're more apt to contract an infection or experience an exacerbation of a latent infection such as genital warts, cold sores, shingles, and whatnot.

Nothing illustrates how doctors ignore the fact that immunity is modifiable more than the following example. Let's say that you see your doctor for a cold, and he tells you that antibiotics won't help because it's caused by a virus. So far, so good. However, if you ask if there is anything else you could do, the doc will likely tell you to take Tylenol^® and drink plenty of fluids. That advice is so commonplace it is virtually a cliché. However, it is also woefully incomplete. In reality, there are dozens of things you can do to improve your immunity; I discuss this in Fascinating Health Secrets. By heightening immunity, the course of the disease is shortened and you're less apt to get sick in the future. In Linda's case, optimizing her immunity would reduce her risk of recurrence of the warts, so I gave her a number of tips that Magoo failed to mention. Perhaps I should have given her another tip, too: find a different gynecologist.