Swine Flu Panic in Retail Healthcare
Since the beginning of the H1N1 (swine flu) pandemic, the public
has relied on retail clinic practitioners to provide education, guidance,
testing, assurance and treatment. The media is playing a vital role in keeping
the public updated; however, I am not sure if this is helpful or harmful. The
public is hearing with only half an ear, only listening when they hear about death by
swine flu. Despite the CDC reports that states, "The majority of people who
contract the virus experience the milder disease and recover without antiviral
treatment or medical care. Of the more serious cases, more than half of
hospitalized people had underlying health conditions or weak immune systems." People sometimes only hear "........Death ............swine flu." They cannot hear
anything before or after these words. People are coming in or calling everyday
with the belief that they or a loved one have the swine flu. I am being
asked constantly, "When is the swine flu vaccine going to be available?" and "Will
I be able to get one?"
In addition to the growing fear, people are starting to
believe that any new symptoms are the beginning of the swine flu. They are
coming into the clinics demanding to be test for the swine flu or given a
prescription for Tamiflu. It is important as healthcare providers that we do
not give in to the fear of the public, and that we continue to deliver sound
and evidence-based medical care. In addition, we must not become totally
business-minded, conducting tests and writing prescriptions without significant
symptoms. The CDC and media continue to warn the public about symptoms to make
them aware but because of their panic state, they are not listening to these
symptoms. The CDC states that signs of influenza A (H1N1) are flu-like,
including fever, cough, headache, muscle and joint pain, sore throat and runny
nose, and sometimes vomiting and diarrhea. I would like to share a few of my
experiences with you.
Fearful parent:
I have a parent that came into the office and stated that he
wanted to be tested for the swine flu because his daughter was seen yesterday
at the pediatrician and diagnosed with swine flu. I asked did the physician perform
a flu test, and he stated, "No, because he did not have time, but he treated her
with Tamiflu and she is now doing better." When asked what his symptoms were,
he stated that he did not have any symptoms. I explained to him that he only
needed to be tested if he is having similar symptoms. Of course, you know what
happened, in an instant he developed a runny nose, sneezing and felt he might
have a fever. Although these are only the symptoms of allergic rhinitis, I
realize that he is not going to be satisfied until he is tested. He also
stated, "I do not want to pass on these symptoms to my job, if I do have the swine
flu." I decided to relieve this man's fear and anxiety be performing a flu
test. You and I both know the results, but I felt that testing this man was
more beneficial, since he felt he was exposed, than not testing him. However,
he did have symptoms of allergic rhinitis, and he was treated with
antihistamines and Flonase. In addition, I provided education about the signs
and symptoms of swine flu and when he should seek treatment, he left a
well-informed man.
Just plain scared:
I had a woman who came to my office a few days after the
swine flu pandemic was announced and she wanted to know if a mark on her face was swine flu. She had a
marked that looked similar to a birthmark or hyperplasia of the skin. I asked
her how long she had the mark. She
states, "About 5 years." I think this is an example of how much fear the swine
flu has caused the public. I assured her that she did not have swine flu and
recommended that she follow up with dermatology regarding the 5-year-old mark
on her face. This woman was actually relieved to hear that the mark on her skin
was prior to the onset of the swine flu and could not be related to the swine
flu.
Panicky moms:
I cannot count the number of moms who bring their child to
the clinic with a runny nose or cough with an onset of 1 or 2 days without
fever or muscle aches for fear that the child has swine flu. I have to educate
and assure these moms daily that their child does not have the swine flu. I do
not test these children if they do not have a fever greater than 101, positive history
of exposure, looks very ill, or complains of feeling very achy. Sure, testing
these kids may be good for business, but it is not medically sound practice. It
is essential that as practitioners, we only provide medically necessary treatment.
We also must realize that we cannot test everyone that has a common cold or
allergy, and that we must be careful not to waste resources that might be
needed later.
Protect myself and family
I have had persons come into the office and ask could I just
give them a prescription for Tamiflu so that they can have it available, if
needed. I took time to educate these people on the use of Tamiflu and the CDC
guideline of only giving Tamiflu to persons who test positive for flu in order
to prevent the virus resistance to the medication. I also explained to them
that we must reserve the Tamiflu for those individuals who are at risk of dying
from the swine flu. The CDC states, "Treatment with oseltamivir or zanamivir
generally is recommended for persons with suspected or confirmed influenza who are at higher risk for
complications (children younger than 5 years old, adults 65 years and older,
pregnant women, persons with certain chronic medical or immunosuppressive
conditions, and persons younger than 19 years of age who are receiving
long-term aspirin therapy)."
These examples are only a small sample of the types of
inappropriate cases that I receive because of media coverage and fear of the
swine flu. We must continue to give the public assurance and guide them as to
when to seek medical treatment. The CDC states the following guidelines as when
a person should seek medical care: "A person should seek medical care if they
experience shortness of breath or difficulty breathing, or if a fever continues
more than three days. For parents with a young child who is ill, seek medical
care if a child has fast or labored breathing, continuing fever or convulsions
(seizures)." However, I deviate from this guideline because I will test a child
who looks extremely ill or listless or have a fever of greater than 101
regardless if it has been less than 3 days. CDC also states that "supportive
care at home, such as resting, drinking plenty of fluids, and using a pain
reliever for aches - is adequate for recovery in most cases." We must continue
to educate and function within the CDC guidelines. If we try to please everyone
by testing and administering medication at patients' requests, we will only
feed into the fear development state. Retail healthcare NPs must help stop
the swine flu madness.