Swine Flu 4.995: Back to the FLUture

OK, it’s not really about swine flu.  We have had a few febrile, sick children test positive for Flu A with our rapid in-office test; we don’t know if it’s H1N1 yet, but at this point it doesn’t really matter.

The CDC site is, as of now, still showing data from May 2010, including this plot which tells us that the cumulative pediatric mortality for H1N1 flu was on the order of seasonal flu mortality for the last 3 years combined.

I said this before and I’ll say this again: many of these fatalities were because of suboptimal guidelines for diagnosis and treatment of the flu — not so much because the guidelines were wrong, but because of our over-reliance on them.  There is no way a government agency can react quickly enough to new information, but individual physicians must use their best judgment at all times, and should not be discouraged from doing so by these agencies, and by our professional organizations.  Guidelines should not become straitjackets.

The initial guidelines said not to do in-office testing for flu.  Well, we did, and it took us maybe 2 days to realize that they did work well, and another 2 days to figure out that many children who were negative the first day of illness, became positive on the second. 

The initial guidelines said not to treat with Tamiflu except for high-risk and seriously sick individuals.  In two days it became clear that those we did not treat would become seriously ill in short order, and we began treating everyone, with excellent results.

The guidelines also did not allow us to suspend preventive care for the duration of the epidemic.  We partially solved the problem of exposure by offering an alternative location for well infant visits, but some patients came for checkups because HMOs sent them reminders and were exposed unnecessarily, and as for others –

The irony, of course, is that while we did a great job handling the epidemic, this very fact caused a drop in our quality indicators which are based almost entirely on preventive care measures.  Overlooking the fact that the best preventive measure for swine flu was staying away from the doctor’s office during the epidemic unless you were actually sick.

Except for suspending some preventive care visits (a sacred cow if ever there was one), all of our approaches were incorporated into guidelines, months later.

So what does this have to do with the flu that we are seeing now?  Just this: at any given time, your doctor will have the best information about the epidemics that are active in your community at that time.

If he or she is still allowed to see sick people, that is.

PS: Come get your flu vaccines!  They do work.    I did the study myself.   We’ll discuss that next time.


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