Still no sign of swine flu in the neighborhood, but the media are busy fanning the flames of panic.  Well, why not?  We do have a problem, might as well have it be pointed out by something as relatively mild as swine flu.

The problem has to do with the dismemberment of inpatient care in the US.  There is something called the

Milliman and Robertson Length-of-Stay Criteria

(basically a wish list from the managed health industry  about how they would like every disease treated by an outpatient or drive-through procedure).

Then there is the tendency to emphasize preventive care at the expense of curative care infrastructure: the money spent on screening and prevention is being generated by closing hospitals, and fewer physicians are doing hospital care now than ever before.  Which is fine, as long as everything you face is preventable.

As yet, swine flu is not very preventable.  Yes, they are working on the vaccine (it is not clear yet how effective it will be, I am hoping for the best, and it is promised for late October), and, yes, thinning the crowds (in schools and elsewhere), proper hygiene, vitamin supplementation and “social distancing” will be useful — but they fall short of complete prevention.  In the meantime, inpatient and intensive care facilities are pared down to bare minimum. It’s a good thing swine flu is only expected to cause a modest increase in need for intensive care — something really nasty like SARS or Spanish flu would have caused a total health care meltdown.  This is a good time for the powers-that-be (within medicine as well as government) to become unobsessed with preventive care and return to what we are really trained to do: treat the sick.  Preventive care, though important, is a fairly cookbook procedure, time consuming mainly because of the amount of advice and guidance to be dispensed, and, as I said before, having a quota of teenagers to bore today can conflict seriously with caring for the sick children in an epidemic setting — let’s think about that for a minute.