Swine flu news : update (5) Fobbing off Guido
Guido takes a break from politics to highlight the current shambles surrounding swine flu. I am ashamed to say that swine flu is being seen by some of my cynical colleagues as a perfect excuse with which to fob off a large number of patients. Let’s look at Guido’s story in detail:
4 year-old Miss Fawkes is in day two of displaying possible Swine Flu symptoms: high temperatures, tummy ache, headaches and a dry cough.Thus starts a typical story of intelligent parents with a young child who is ill. They do not rush to the doctor, or phone NHS Direct as soon as the child sneezes. They have probably temporised with Calpol and fluids and TLC but by the end of the second day the temperature is still high and they want some advice.
Fob Off 1Guido does not say if his daughter was seen and examined by a doctor. The strong implication is that she was not. Instead, she is unceremoniously despatched off to a quacktitioner “walk-in” centre. They are far too important and busy to see a child with a temperature above 39.0.
Last night a worried mother took Miss Fawkes (who had a temperature of 39.1 C / 102.3 F) to the paediatric A & E unit of a London hospital where she was given a mask and told to go instead to a walk-in unit.
Fob Off 2Even the quacktitioner was too busy. Miss Fawkes thus goes home without having had a medical assessment.
The walk-in unit told her there was a four-hour wait and that she might as well go home and see her GP.
Fob Off 3This is particularly disgraceful. It makes me ashamed. The GP's receptionist making decisions like this is the ultimate quacktitioner rampant. How dare she fob off a child with a high temperature? She may invoke the Nuremberg defence. Well, if the GPs for whom she works have really told their staff to send home children with temperatures of over 39.0 before they have seen a doctor, they should be struck off. And I don’t care what government protocol they produce. They should be struck off.
This morning the GP’s receptionist said that they could not have a suspected case of Swine Flu in the waiting room and she was to go home.
Guido
Fob Off 4May not sound like a fob-off, but it is. The GP who has not sees Miss Fawkes personally but decides to make a telephone diagnosis and provide some Tamiflu. Great. I wonder, though, does he tell Guido that Tamiflu is next to bloody useless as a treatment? That given at the onset of the illness the best you can expect is that it may shorten the duration of the illness by twenty-four hours? I doubt it.
GP just called and we have finally arranged to pick up a prescription. A co-conspirator also emailed to very generously offer his private Tamiflu drugs stash.
The next day, the good news.
Just a quick update since so many co-conspirators (and even a few sworn enemies) have been kind enough to enquire. 4-year-old Miss Fawkes is reluctantly taking a Tamiflu / chocolate Nutella compound. She seems firmly on the mend. Fever is past, a little lethargic and a low appetite persists.Miss Fawkes is getting better. So, it probably was not swine flu, although one can’t be certain. And Guido seems a little perturbed that swabs were not done so enable a more certain diagnosis to be made.
Guido
There is little now that can be done to stop the spread of swine flu. It is not possible to swab all suspects and in any case, if you are going to play the Tamiflu game, you have to start playing long before the swab result comes back. Fortunatley, as yet, it seems that swine flu is a relatively mild illness, milder than the routine seasonal flu that doctors see all the time but which the media ignores. If this outbreak had been caused by a virus called the “really rather dull and boring” virus we might have heard little of it.
It is convenient for the government and Donald Rumsfeld (all the dirt on Donald is here) to pretend that Tamiflu is a magic answer to the problem, but in reality it is of little use. It may have some prophylactic effect but the logistics of prophylaxis (who? when? how often?) are so complex that the government seems to have given up.
In the meantime, though, other illnesses continue as normal. Children still get meningitis, and may well present with high temperatures, tummy ache, headaches and a dry cough. Children still get bacterial pneumonia and may well present with high temperatures, tummy ache, headaches and a dry cough. Children still get pyelonephritis (kidney infections) and may well present with high temperatures, tummy ache, headaches and a dry cough. Children still get acute appendicitis and may well present with high temperatures, tummy ache, headaches and a dry cough. Children still get acute leukaemia and may well present with high temperatures, tummy ache, headaches and a dry cough.
I labour the point deliberately. Adults with serious illnesses may sometimes present with bafflingly non-specific symptoms. Small children with serious illness frequently present with bafflingly non-specific symptoms and, to make matters worse, unlike adults they often cannot give a detailed history.
If we continue to “treat” children with temperatures over 39.0 in the way Miss Fawkes was treated, there will be a tragedy. And, when it happens, the media will give no quarter.
“Mrs Jones phoned the GP/the hospital/the walk-in centre and was told over the telephone that her daughter, Mary, had swine flu. They left out a prescription for Tamiflu but Mary died the next day from meningococcal septicaemia.”For once, Dr Crippen will agree with the media.
Labels: Guido Fawkes, Rumsfeld, Swine flu nonsense, Tamiflu
51 Comments:
Generally I think I agree with my esteemed colleague here.
I think if a child, and child, turns up at my surgery, they will be seen by a doctor, not a nurse and certainly not sent away.
I know that the receptions were 'only obeying orders' but here I am with ST. Thomas Aquinas - good people should not obey the law too well.
Harrrumph!!
John,
How do you feel about diagnosing swine flu over the phone and authorising Tamiflu in adults?
Burnham said that we would be doing so in his statement in Westminster and this is also the advice of our local PCT.
At a meeting last week I asked specifically about the risk of missing a septicaemia and as to whether we, as GPs, will have crown immunity here.
I didn't get an answer, just waffle.
Couldn't agree more. A perfect example of the "its not my problem see another agency" thinking that defines the modern NHS. The whole command and control algorythmn driven approach seems madness to me - was there any coalface GP input into this (don't laugh).
I would sack any of my receptionists on the spot if they sent an ill child away before I saw them. I would also never diagnose an ill child over the telephone - absolutely crazy that any GP with any claim to competance (or even a clear conscience) would even think about it!
I am an A&E nurse. I am qualified to triage patients - not diagnose or discharge them. During the earlier days of this swine flu, a patient came into triage with a 3 day history of flu symptoms. I followed protocol isolating him and giving him a mask. I then went to the A&E registrar and informed them of the attendance.
I was told to 'go and send him home'. I refused, as thats not my job. I was told that 'its not appropriate etc etc...you need to tell him to go etc etc...' I argued my point. I am not a doctor, I cannot tell you if he has pneumonia, meningitis etc etc. Discharging him is not my responsibilty. And as a nurse, I am not here to 'follow orders'. That is no defence for me should patient collapse and die.
I stood my ground and refused.
And I would never send a pyrexial child away, swine flu or no swine flu.
How do you feel about diagnosing swine flu over the phone and authorising Tamiflu in adults?
++++++
Well, much the same, but if the shit hits the fan, and we have thousands, we are going to have to make some difficult decision. I shall see all the children. If the adult is coherent, competent, not alone, and the history is strongly suggestive, I may have to say that it is "probably" flu...... but I don't like it
John
dr C
hey youre catching on to one of my themes, what 2 years or so after i started having a pop
long before swine flu hit the news the receptionists were making life and death decisions in many a GP surgery Ive seen 1st hand
and they are so obviously badly trained for that role
long overdue an overhaul
and since it is so common that ive seen in 1st hand dozens of times in different places i suspect that their GP being struck off is ever so unlikely to happen, as its hardly a secret is it?
now lets see you do some mystery shopping around some GP surgeries, and get writing those formal complaints against the many GPs that allow this to happen
im waiting..........
it is predicted that in our 2 partner practice of 6500 patients we should expect 160 patients with flu every week. it will be impossible for us to see this number of extra patients, even if it were the risk of infecting the entire surgery staff approaches a certainty. whilst the official advice isnt perfect, it is at least pragmatic.
No one why are you going to so many different GP practices?
Seeing it dozens of times in many different places...i wonder if they receptionists know you and do it on purpose?
anonymous (17:05) said ........ even if it were the risk of infecting the entire surgery staff approaches a certainty.
Yes, this is what is happened in A&E - several doctors and nurses off with swine flu (most confirmed by swab). We are short staffed and this impacts on the standards we can offer.
Nowadays everybody is suffering from a dreadful disease until proven otherwise by a doctor.
Does an otherwise healthy child with a cough and temperature really need to be taken to A&E as the first port of call?
"Does an otherwise healthy child with a cough and temperature really need to be taken to A&E as the first port of call?"
No, and they don't need to see a GP either. The vast majority, as you know get better on their own.
Nowadays, however, if you are ill you are basically encouraged, especially by the mendacious bastards in government now, to abdicate any personal responsibility and pass the buck to a member of the medical fraternity.
The media-led and government-led panic about swine-flu will ensure massive inappropriate prescribing of useless drugs as everyone covers their arses.
This government promotes reliance on the State and this is a perfect opportunity for them to stoke that fire with the help of a complaint and utterly disgraced (in the eyes of most in the Medical profession) Chief Medical Officer.
Sorry you're still having such a hard time w/swine flu. Seems to have become a non-issue over here. Read in the Asahi Shimbun that Tamiflu-resistant swine flu has been confirmed in Japan. Is that a function of their practice of handing out Tamiflu like candy for regular flu, or are there other possibilities?
My girlfriend recently went to her local practice to make an appointment for *very* severe eczema. The receptionist suggested [in all seriousness] that she would get better results from seeing a homeopath than a GP. She even handed over a card for a local homeopath.
Now eczema is one thing but I wonder if this receptionist can distinguish it from basal cell carcinoma, squamous cell carcinoma, necrotising fasciitis, or Paget's disease. I have seen all of these look very eczema-like and don't imagine a homeopath would contribute much to the management of these conditions.
It's estimated that the figures for swine flu will be 100,000 per day come August. It just isn't possible for a GP to see every child of 'worried well' parents. It's these bastard parents who will be killing those who most need the services of their GP.
But of course it's the government's fault. Not the overuse of vaccines, just like we overused antibiotics.
I had hong kong flu in 1969 at the age of 8 which developed into pneumonia. I was very ill and luckily suffered no side effects. In those days the GP came out to see a sick child. My parents, who both worked, had little time for fakers and in this case it was clear I wasn't.
Well Anon 10.40pm, thank goodness your parents knew what was serious while all those other silly parents are simply wasting GPs' time and - let me check your comment again..oh, yes - killing other people too.
To all those critics of the catch-all 'middle-class, worried well' parents, I defy anyone who is not medically trained to know exactly the right time to seek medical help when your child is ill. Talking in abstract about it is one thing but sitting in their bedroom all night watching them getting hotter and hotter and sadder and sadder is quite another. When the choice is between possibly wasting five minutes of a GP's time or waiting too long and your child becoming seriously ill or worse while you look on, it's a fairly simple choice to make.
Scribbler, i am medically trained and i don't know when the best time to seek medical help for kids is either. Just have to hope the other half settles on paeds as a career.
I entirely agree with the comments about missing other causes of a pyrexial illness in the absence of a clinical assessment of an illness with a non-specific presentation.
It will be fascinating to see how the new policy works in practice. Given the impossibility of differentiating clinically, or telephonically, the relatively mild illness that H1N1 usually produces from the common cold, a high proportion of the Tamiflu prescribed by GPs is likely to go to people not suffering from H1N1 infection. This will provide a perfect opportunity to see just what the range of its side effects are. The list in the BNF is worrying in itself. ("nausea, vomiting, abdominal pain, diarrhoea; headache; conjunctivitis; less commonly rash; also reported, hepatitis, arrhythmias, neuropsychiatric disorders (in children and adolescents), visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis"). It bears the BNF stigmata of the little black inverted triangle indicating that all side effects be reported. So stock up on those yellow forms.
Of course, a more cynical view might be that the government, having bought millions of doses of a drug about to become useless as resistance to it develops, wants to minise electoral damage by pushing it into the ocean via the electorate's kidneys rather than be seen to be burning it.
John Woolman said .......... I entirely agree with the comments about missing other causes of a pyrexial illness in the absence of a clinical assessment of an illness with a non-specific presentation.
Are you saying that EVERYBODY who has a temperature must see a doctor?
After all how are untrained members of the general public expected to know if are they are brewing some dreadful disease?
And even if the symptoms seem relatively benign at a given point in time surely it would be prudent to provide a succession of follow ups so as not to miss a rare cases of prodromal meningitis, etc.
We could build a series of annexes which could perhaps be called Polyclinics where these endless checks could be offered - lets face it there is presently no excess capacity in general practice, A&E or, indeed, Walk-in-Centres, which are all seeing more and more patients every year?
It goes with saying that ambulance call outs have gone through the roof as well with at least a doubling over the last 10 years.
Where does it all end?
This is Flat Earth news. Guido is guilty of promoting it.
Hyacinth Bucket sat behind her glass window and receptioned. The G.Ps took to using an intercom to get patients from the waiting room because they were scared she would collar one of them if they passed reception and invite them to one of her candle lit suppers. Dr Crippen was glad she was there as it ment he could channel his artistic tendancies into his blog.
Geepee mum was glad coz it ment she could spend the first 20 minutes of surgery talking to another mummy on the phone about running a "hook the duck" stall at the local fair on saturday. A/E charge nurse was glad because he always found it hard to staff the paeds part of A/E anyway. the G.P. practise smelt of polish and surgical spirit and freash flowers in silver vases raised the tone.
capgrass nursed her six year old at home, using Calpol, neurofen and cold baths. Eventually when the meds ran out...she phoned NHS direct who said a registered nurse would call her back in 8 hours. Capgrass went to A.E. and it was found the child had a spiral fracture.
Dr Crippen,
I was appalled and outraged by Guido's experiences. It's clearly critical to 'de-centralize' the NHS -
get 'back to basics' and proper care.
A sick child is very alarming for parents and I remain ever grateful for advice given to me by a relative, an experienced A & E sister, regarding the dangers of an untreated high temperature in small children - an epileptic fit, even death - invariably posing as great a risk as the illness.
I could not believe that the temperature of 102.3 Guido reported failed to ring alarm bells.
the a&'echarge nurse,
There are healthier options than increasing three generational debt on profit focussed PFI's in the NHS, proposed polyclinics being yet another staffed by 'box ticking' armies.
Far better to spend funding on 'direct care', localized also saving the environment from unnecessary pollution. All pregnant women to be fully informed on health issues via booklets and post natally - 'in the event of x,y, z' act as follows'. Health visitors should be available at each and every local surgery for mothers' health concerns with their children - GPs readily available as needed
Labour's proposed demolition of systems and buildings which have worked for generations is not in patients' best interests, nor debt written taxpayers and last, but not least, increases travel and pollution.
I won't dare to pronounce a patient (adult or child) "doesn't need to see a doctor" until I have seen him.
Wow, the level of craziness around Swine Flu seems to know no bounds - its pretty sad to see that the hysteria has even began to affect of esteemed medical institutions.
Im not a health professional, but if anyone that i worked with started behaving like this i would be very disappointed.
Thanks for the insight. Your blog is funny and informative, a great insight into the world of a real life doc.
I'm sorry that Guido was fobbed off, and I'm glad Miss Fawkes is better.
It would indeed be tragic if diagnoses of meningococcal septicaemia and other serious febrile illnesses were fatally delayed thanks to the current swine flu hype (and associated guidelines/procedures).
But thankfully these serious illnesses are rare, and this is not the big problem I see with the DH's current handling of swine flu (although it is related). It's the indiscriminate spraying of tamiflu around the population that really bothers me.
We're still advised to offer it to everyone... although with some talk of prioritisation now at last some commonsense is starting to creep into the guidance. It's on offer as a magic cure-all pill for all. Of course everyone wants it (even to the point- *gasp*- of trying to get a private prescription). And systems are in place to ensure that all can get it- perhaps not working so well in Guido's part of London, but seems pretty easy round here.
Meanwhile the smaller-print stuff in the guidance gets ignored. None of the practices I've locummed in the last 2 wks have a designated flu room, or separate waiting areas for flu patients, or alcohol gel dispensers or masks or designated flu doctors etc etc- all of which is probably unnecessary with SF being so mild anyway, but would be crucial if it was a nastier illness. These measures might be in place now if we didn't have the sop of a magic pill called tamiflu. With larger GP practices or designated centres set up accordingly, Miss Fawkes and others could be assessed safely and appropriately with less worry of her sneezing aerosolised virus into crowded, non-segregrated waiting rooms.
There's already tamiflu resistance in Hong Kong and Denmark. At this rate it'll be here too, sooner rather than later. If tamiflu goes nasty on us later in the year we'll be in trouble- or, more precisely, thousands (or millions) of higher risk patients will be in trouble. Or it could be H5N1 a few years later, developing sustained human-to-human transmission and picking up tamiflu resistance genes from H1N1. Either way, the pills will no longer work in the people who need them- and whatever marginal benefit they confer- the most. But I'm sure that won't stop us from busily setting up antiviral distribution centres and developing the appropriate protocols, rather than just cracking on with decent infection control.
So please, please let's stop handing out antivirals to healthy people with what's so far proving to be a mind-numbingly boringly mild illness.
Noticed a typo in the above- tamiflu for swine flu in the penultimate paragraph. Should read the preview more carefully.
Anyway, I'm going to take swine flu as my jumping off point into the blogosphere. In case anyone's interested, further thoughts will be periodically posted here:
http://gpswine.blogspot.com/
GP locum schweinhund wrote:
'So please, please let's stop handing out antivirals to healthy people with what's so far proving to be a mind-numbingly boringly mild illness.'
It's obvious that you don't understand what's going on here.
' . . .handing out antivirals to healthy people' is not a fault of the NHS, nor even of the doctors working within it - this is all the doing of the evil Donald Rumsfeld, who uses his satanic mind-altering powers to force the NHS to recommend Tamiflu, and doctors to prescribe it. All are powerless before his evil machinations.
Must be true. Our genial host says so.
llater,
llamas
Swine flu is a mild self limiting illness in most cases, I know that, but how many of you have actually had it? I am on the tail end of a nasty bout of confirmed swine flu as is my five year old and let me tell you - it is nasty. My little one was spiking temps of 40.5 and was listless, vomiting, coughing and feeling generally miserable. The calpol and nurofen having very little effect in bringing down his temp so I had to give frequent tepid sponges which did have effect. I have to say, the out of hours doctor through NHS direct in Scotland did come out to see him and when we got home to England I contacted my GP who did a phone assessment which I was entirely happy about as I had been in contact with known swine flu through the course of my work. My little one did start on Tamiflu, mainly due to his high temps, which may or may have not made any difference but at least made me feel better. I am also on Tamiflu as I have asthma but who knows if it is making any difference? I was also assessed over the phone which I am absolutely fine with. I have seen how easily it spreads from person to person as now my 2 older children have it as do my next door neighbours. The last thing I want to do is spread it around my local GP practice or A&E department. Anyway, swine flu is crap and trust me, it might be considered mild by the medical fraternity but I can't remember when I have been this unwell.
Must be true. Our genial host says so.
llater,
llamas
+++++++
Just so!
John
the a&'echarge nurse,
There are healthier options than increasing three generational debt on profit focussed PFI's in the NHS, proposed polyclinics being yet another staffed by 'box ticking' armies.
Far better to spend funding on 'direct care', localized also saving the environment from unnecessary pollution. All pregnant women to be fully informed on health issues via booklets and post natally - 'in the event of x,y, z' act as follows'. Health visitors should be available at each and every local surgery for mothers' health concerns with their children - GPs readily available as needed
Labour's proposed demolition of systems and buildings which have worked for generations is not in patients' best interests, nor debt written taxpayers and last, but not least, increases travel and pollution.
Anonymous - 10.40 p.m.
Your 'pie in the sky' prediction of 100,000 swine flu cases per day by the end of August begs the question - do you have a vested financial interest in the 'illness' ?
Health officials on Monday confirmed 865 cases to date.
Oh dear last anonymous, don't blame anonymous @10.40 for the 100,000 figure, blame the government, or rather their epidemiological advisers.
The figure is here:
http://www.bmj.com/cgi/content/full/339/jul03_2/b2721?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=swine+flu&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT
Yes, I know its the BMJ but at least its not the bloody Daily Mail.
WHO are quoting 94512 cases as of yesterday with 429 deaths, a mortality of 0.45% so far. Given the current exponential rise, virulence & means of rapid droplet spread, the figure quoted seems vaguely reasonable to me (with my basic epidemiological & microbiological knowledge).
Addendum:
To quote Andy Burnham (he's the health secretary):
""Cases are doubling every week and on this trend we could see over 100,000 cases per day by the end of August."
Maybe a little insensitive I know but this was my 'wicked sense of humour' take on what to do if you have Swine Flu.
Anonymous (7:25) said ......... "anyway, swine flu is crap and trust me, it might be considered mild by the medical fraternity but I can't remember when I have been this unwell".
Nobody is doubting that swine flu can produce unpleasant symptoms - the question is should tamiflu be given for an essentially benign and self limiting illness (assuming the patient is otherwise well).
On the one hand tamiflu is said to shorten the course of swine flu by a day or two, and dampen the severity of symptoms - on the other resistance to this antiviral has already emerged in Denmark so there is a danger that this may herald the evolution of a more dangerous bug.
When it comes to upper respiratory tract infections NICE are now recommending that we abandon antibiotics altogether (jn the vast majority of cases). Why has it taken so long for this self evident measure to be finally implemented?
NICE (2008) Respiratory tract infections – antibiotic prescribing
http://www.nice.org.uk/nicemedia/pdf/CG69QRG.pdf
It's just a pity Liam Donaldson did not advocate the same approach for tamiflu, accepting that it may be indicated for certain vulnerable groups - the answer is public hysteria is once again exerting an undue influence on scientific facts.
remind me again.......how many people die of malaria, aids, tetanus, measles, EVERYDAY?
Isn't it unethical to turn a patient away if they're asking for a consultation? Then again, isn't it also unethical to possibly expose every other patient to a potentially dangerous condition?
the a&e charge nurse said
It's just a pity Liam Donaldson did not advocate the same approach for tamiflu, accepting that it may be indicated for certain vulnerable groups
Indeed it is but this would have involved admitting that stockpiling enough Tamiflu for every man, women,child and pet dog in the country was a collossal waste of money and also that the hysteria and planning frenzy was completely OTT for what is essentially an unpleasant but self-limiting illness.
Well, we in hospital have been making a few plans. Or rather, the plans have been handed down from on high. Some are based on reality, some pure fantasy. We have been looking at how many patients we can ventilate, and how to allocate resources. Even then, not all elective surgery will stop. Would not want to affect waiting times, would we?
This is all predicated on our dedicated, underpaid nursing staff doing extra work in unfamiliar areas. As well as the lazy consultants, but I suppose they don't count.
Well, let me tell you what is most likely to happen. If this get bad nurseries and schools will close, nurses and others will stay home to look after them as they will not want to expose their children to the risk of infection, and the hospitals will find themselves very short of staff.
When I mentioned this some bright spark said 'Oh, that won't happen' and then followed it up with 'well, we could have a large creche so parents could work'
What planet do these pillocks live on? In the middle of an explosion of a disease which may well become more serious, do they really think that staff will bring their well children in to a hospital to be with a lot of others, so they are virtually guaranteed to get ill?
Idiots. I will be there, my kids have left home. So the hospitals will be run by older generation doctors who trained under the old system before the government fucked it up and know how to do more than follow a protocol......
Not so bad?
Until we get ill, of course. But then we are probably too old for the infection protocol and will be left in the modern version of Scutari to quietly pop our clogs.
Oh well.
I'm still seriously underwhelmed by this pig sniffle nonsense.
A pandemic of.... what? Mild flu you say?
Influenza is a deeply unpleasant and potentialy dangerous illness. But swine flu appears thus far to probably have a lower mortality rate than usual seasonal varieties.
So why all the bleedin' hoopla?
A&ECN - thanks for the link to the ever lovely NICE guidelines.
I do take issue with your assessment as "When it comes to upper respiratory tract infections NICE are now recommending that we abandon antibiotics altogether (in the vast majority of cases)" when the leaflet specifically states this is for 'self-limiting RTIs'
However, I take much bigger issue with the fucktards telling me to take a history (apparently this involves asking some questions about presenting symptoms) and then, to exam the patient as needed followed finally by 'addressing the patients/carers concerns and expectations'. So if the patient demands antibiotics, NICE tells me to give them. Oh, and apparently I should also give them if they are 'very unwell'.
Just out of interest, how much does NICE cost the taxpayer each year?
Fuck me, why did I bother with medical school when I could have learned it all from a simple cut-out-and-keep reference guide that folds nicely into my pocket.
It's not just NICE anonymous at 1:35, what about Zwart et al [2003] who state;
“in view of the extremely low incidence of potentially severe post-streptococcal sequelae such as rheumatic fever (or glomerulonephritis) in affluent Western communities, rising antibiotic resistance rates, and the high carrier rate of group A streptococci in children, we advocate prudent prescription behaviour with respect to penicillin. General practitioners are recommended to treat children having an acute sore throat ONLY when they are severely ill (unable to drink, an imminent quinsy) or at high risk (history of rheumatic fever, having an anatomical or immunological disorder, high incidence of streptococcal infections in the community).
While according to this lot the evidence for giving antibiotics for sore throats (Ben-David 2002, Hirschmann 2002) sinusitis (Leggett, 2004) and acute otitis media (Darrow et al 2003, Schilder et al 2004) is equivocal at best.
80% of UK antibiotic prescriptions are generated in the community and of these 50% are for URTIs - in the main such prescriptions are not only a waste of time and money but more worryingly they are contributing to bug resistance for which the NHS has an unimpressive record (although it is belatedly starting to improve).
It all has to stop so it is disappointing to hear that tamiflu is being dished out to the worried well.
Dr C,
Have you watched the Michael Moore film "Sicko"? I saw it yesterday and think it's well worth watching. In spite of its flaws (and it does have MANY flaws), don't you think the NHS is better than the kind of health care Americans get?
Neelu
Neelu wrote:
'Have you watched the Michael Moore film "Sicko"? I saw it yesterday and think it's well worth watching. In spite of its flaws (and it does have MANY flaws), don't you think the NHS is better than the kind of health care Americans get?'
Anyone who uses a Michael Moore film as a real-world reference for - well, anything, actually - needs a short, sharp reality check. Moore's misleadings and mendacities have been so thoroughly debunked that if he said the sky was blue, I would step out to check. He is a hard-left political propagandist who uses a folksy demeanour to hide the fact that he is producing a party-political broadcast.
As to your question - ground bait, which I would do well to leave alone . . . .
llater,
llamas
Llamas re Moore:
So he's basically the exact opposite of you then.
Where has this 'thorough debunking' taken place (other than a few self-serving website who seem to represent the same agenda as yourself)? I must have missed it.
Llaterz
AnonymouZ
AnonymouZ wrote:
'a few self-serving website who seem to represent the same agenda as yourself . . .
You mean, like CBS News, hosting the editor of that famous conservative publication, 'The New Republic'?
http://www.cbsnews.com/stories/2004/06/28/opinion/main626484.shtml
Or perhaps you meant that well-known right-wing rag, Newsweek?
http://www.newsweek.com/id/53910
Or the fascists at CNN?
http://www.cnn.com/2007/HEALTH/06/28/sicko.fact.check/index.html
Or perhaps that well-known right-wing ideologue, Christopher Hitchens, writing on the popular self-serving website, Slate?
http://www.slate.com/id/2102723/
Or the well-known liars at Forbes magazine?
http://www.forbes.com/forbes/2002/1209/059.html?_requestid=2372
Or pehaps you meant something different - who knows?
Moore is part-polemicist, part-fabulist, who has figured out how to use the medium of film to spread a far-left ideology while reaping vast personal rewards. His carefully-presented 'man-of-the-people' persona is part of that. If you want to believe the one-dimensional and simplified stories he carefully-chooses to tell, go ahead.
llater,
llamas
Word verification = 'lethal'. You decide.
Pregnant? Think you have swine flu? Phone your midwife and ask her to visit, well that's what our local G.P surgery has been advising. Two problems here - 1) I am not a doctor. I cannot diagnose or prescribe. 2) I spend my entire working day in close contact with neonates, therefore it would be a good idea for me not to deliberately have close contact with persons who have swine flu.
Llamas,
Thanks for proving my point. Trouble is that single-cause people with self-serving agendas like yourself can only identify other single-cause self-serving people too.
Llaterz
Anonymouz
Word verification = 'privatise_everything'
You decide
Mm. Two weeks ago I had a high temperature, abdominal pain and the shakes. Normally I would suspect cellulitis, as my scar tissue and skin grafts make me prone to it.
However, the characteristic rash didn't show up until the third day.
Luckily I have a friend who works at the walk in centre, who's had it as well, and he got me to the front of the queue for a bucket load of fluclox.
With swine flu going on, a MOP would probably have died of septicaemia. As it was, I wound up off work for a week with massive blistering and penicillin diarrhoea.
I just found out today that my daughter has Swine flu - she called to ask me to go to a specific pharmacy to collect her prescription for Tamiflu, but having read your thoughts on this I don't expect it to be a miracle cure - kept that bit quiet from darling daughter (who is an adult 29 by the way) as it seems better for her to think of it as a sort of 'miracle cure' - The were large signs in the pharmacy that anyone with suspected swine flu should leave the pharmacy immediately
I am not concerned too much for her or myself, but am certainly concerned for my 90 year old father and will be keeping him well away from his granddaughter for the next few weeks.
Ah well.... she is young and strong, and, as far as I am aware, has no "other issues" as it seems the media is suggesting the ones who have died from this condition. So I have high hopes that all will be well
Steve
At the end of the day Swine flu is similar to normal flu.
Gratton Woodson MD FACP has written a excellent guide to the practical treatment of flu.
"It is in the nature of all influenza pandemics to cause widespread illness and death. As during seasonal flu, the vast majority of those sick with pandemic flu will be treated at home by their family members and friends. This guide was written for people taking care of mild to severely ill influenza patients in their home who have no formal medical training."
It can be downloaded from here
http://swinefludisease.netne.net/
Overwhelming evidence backed up by publicly available research data shows that vaccines containing Thimeresol harms children’s brains. Even though the pharmaceutical companies and governments won’t admit it, we do not need an official declaration to know that they are in fact unsafe. Both governments and pharmaceutical companies can be found liable if they were to officially admit that Thimerseol in vaccines and other aluminum based ingredients do in fact harm children’s brain. This is why they will not officially declare these types of vaccines unsafe. Visit http://fluhealer.blogspot.com to get your latest Swine Flu Pandemic updates.
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