I once heard from a patient, "You know you have the flu when your hair hurts." Well my hair hurts today, not because I have the flu but it certainly seems as if everyone else does.
I received my flu shot for the common seasonal flu over a month ago. Now city officials say all the current flu circulating is the swine variety. This is a problem since there is no vaccine. The hospital asked for 7,000 doses. They received less than 700. Pregnant employees in the emergency room and women's and children's services were the first to be vaccinated. Other pregnant employees will be next.
Flu is a dangerous disease in pregnancy. It can lead to pneumonia and hypoxia, a fancy word for too little oxygen. As you can imagine, too little oxygen is not good for mother or baby. We have had several mothers and mothers to be in the intensive care unit. So far we have not had a maternal death but we have come very close - twice.
I try not to think about getting the flu and I must admit, I am more afraid for my sons than for myself. The young seem to be very vulnerable to this virus. One patient who was in the ICU for two weeks is the same age as my oldest. He is not pregnant but he has an underlying medical condition. I will not hestitate to give him an antiviral should he or anyone in our household comes down with the swine flu.
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Musings of a physician in private practice for 24 years, now teaching in a residency program and working as an ob-gyn hospitalist in a large metropolitan hospital.
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The Local MD
Having now been a physician in private practice for twenty-one years, twenty-six days and about an hour and twenty minutes, it occurs to me that I have become what in medical school was often a derogatory term, the local MD.The presentation on rounds often went something like: "This 45 year old Caucasian male was seen last week by his LMD, and diagnosed with a viral upper respiratory infection..." At that point everyone knew that the LMD had missed the diagnosis. Otherwise the poor patient would not have ended up in a tertiary medical center with three consulting specialist, a fellow, a resident and four medical students at his bedside.What we, the medical students, the resident, the fellow and even the attending hospital physicians did not realize is that we would never know John Smith as well as the LMD. We would never speak to his wife using her first name. We would never be able to recall the names of all his children and know where they were in the world. We would never remember his favorite hobby let alone joke with him about it. Nor would we shed a heart felt tear when we gave him the diagnosis of the aggressive small cell carcinoma of the lung that had landed him in our midst and would kill him in less than three months despite our aggressive treatment that was the best medical science has to offer.At that point in my life I was very proud to be even the lowest ranking person on the team that was on the cutting edge of the diagnosis and the treatment of the gravest of conditions that plagued mankind. I felt so very lucky that I was being initiated in to this sacred fraternity. That I would soon be able to write "MD" after my name. I am still proud of my vocation yet I believe there is a wisdom that has only come with those twenty-years of practice.Today I realize what people want most of their physician is that he or she is someone who cares.Yes, we all want "everything medical science has to offer." Yet, what most of patients need is someone who will listen with their heart as well as with their head. Physician eyes are important, not only for seeing signs of disease in the body but for making contact with the patient's eyes where we are often allowed to see into their soul. All of the technology in the world will not replace a warm clasp of the hand or sitting at the bedside to share a few moments of the day along with the test results.So, I have created this blog. In large part it is a place for me to put my feelings. My hope is that at least some of these posts will resonate with others out there. Not just physicians, but others in caregiving vocations and even those for whom we care. If we are not here for each other then why are we here?
3 comments:
What do you think about the current policy of not testing to see if patients have H1N1? I think that my son had it, he as exposed, then developed symptoms and I promptly put him on Tamiflu, he was sick for several days but not alarmingly sick. Now I do not know if he has had it or not and in a dormitory setting, I am going to get the vaccine for him if I can find it. If I knew for sure that he had it, then there would be no need for the vaccine and someone else who has not had H1N1 could get the vaccine. Would it not make more sense to test everyone with a suspected case, so that the few vaccines available can be given to people who have not already had it?
In the hospital where I practice, when we first began seeing cases, the lab was set up to do the rapid test only and the PCR had to be sent out, requiring 48 hours. We had several negative rapid tests where the PCR then came back positive. One patient was in the ICU before her PCR came back positive. Since that time (2 months) we have been treating everyone with a negative test and stopping treatment if the PCR is negative. We now have a shorter turn around (4 to 12 hours depending on the time of day). My experience with the rapid test is a high false negative rate exists.
So, I say all this to say, those who are at high risk (I deal primarily with pregnant patients but people with asthma and diabetes, anyone who has to take steriods or is immunosuppressed)should be treated. Again, in the population I serve, a number of patients have no insurance and frequently either no phone number or they do not give a correct phone number so they are more difficult to find for collections.
I would guess the ER sees several hundred people a day with flu symptoms. Just seeing them is a problem. I hope this helps you understand how protocols are set up, especially with large numbers such as college students. And YES, I would also vaccinate him if you can get the vaccine.
I understand not testing in an ER setting, but what about in the pediatrician's office where the parents, kids and doctors have an ongoing relationship of years and they know that they can call and give them the results? And where the parents are willing to pay for the test? It seems to me, that we could lessen the need for the vaccine by testing these kids.
I will be vaccinating my kids when I can get it, but wish that I knew if they had already had it, so that I could free up two vaccines for other kids who may not have been exposed yet.
Thanks for answering!
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