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R.I. pediatricians swamped by parents concerned about flu
10:31 AM EST on Thursday, November 12, 2009
By Felice J. Freyer
Journal Medical Writer
Dr. Marcolino Ferretti of East Bay Pediatrics & Adolescent Medicine in Barrington examines Jordyn Raftery as her mom, Lisa Raftery, of Lincoln, looks on. Jordyn was sent home from school with a fever and cough and her mom was worried she had swine flu. The Providence Journal / John Freidah
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Susan Ginn, of East Providence, has her infant son Gabriel receive the H1N1 vaccine at East Bay Pediatrics & Adolescent Medicine.
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Kathy Baldwin, of Warren, takes her son 15-month-old son Dylan in to see Dr. Marcolino Ferretti this week.
The Providence Journal / John Freidah
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These days the doctors who care for children work into the evening and through the weekends. They take faxes and mail from patients who could not penetrate the overloaded phone lines.
To parent after parent, they explain why they can?t do a flu test, why they won?t prescribe Tamiflu, why they?re still waiting for vaccine. They try to separate the sick from the well in packed waiting rooms. They dispense advice, reassurance and face masks ?? but no cure.
In a few instances, they deflect insults, threats and even bribes.
All in all, the pediatricians of Rhode Island have never seen anything like this.
The swine flu epidemic has exploded, more than any other place, in the offices of pediatricians and family doctors ? bringing a time- and emotion-sapping convergence of sickness, fear, demand for vaccine and need for information.
?I feel like I ran a marathon and got hit by a truck,? said Dr. Jacques Benun, a pediatrician at the primary-care clinic at Hasbro Children?s Hospital, adding that his exhaustion was more mental than physical. ?I?ve never worked this hard in my life.?
?The volume is insane,? Benun adds. ?Just so you get an idea, on Friday we saw 196 patients in eight hours? ?? double the usual number.
Most of the children seeking care are not very sick, because swine flu is a relatively mild infection. Some aren?t sick at all. ?They come in, just in case, because they?re worried,? Benun said. ?There?s this fear that there?s going to be death.?
In fact, there has been death. After two 12-year-old girls died of swine flu within a week, pediatricians saw the volume of calls soar.
In a typical year, one or two Rhode Island children die of the flu, but those deaths attract little notice. The death rate from swine flu is about the same as for seasonal flu, possibly lower, with less than 1 percent succumbing. But with many more kids getting sick, the number of deaths may be higher. And each one gets reported in the media.
When parents are concerned, pediatricians want to see the child. But the publicity about swine flu has heightened concern ? among both doctors and patients.
?Everyone is frightened,? Dr. Martha A. Ullman, a pediatrician with Aquidneck Medical Associates in Newport, wrote in an e-mail. ?With two deaths in this small state everyone wonders who is next. I have told a few that I, too, am frightened. Just enough to be very careful. So we screen each child carefully and make the best decisions we can.?
At the health center at East Bay Community Action in East Providence, the staff has already had a patient die from swine flu ? an adult. The 49-year-old Riverside woman who died on Nov. 2 had been a patient at the center, which treats both children and adults.
?We?re all affected by [the deaths]. We?re devastated to lose a patient to H1N1,? said Dr. Sarah J. Fessler, the family doctor who is the center?s medical director. ?We bring them in if people are concerned. We?ve had a low threshold for people coming in.?
Dr. Bob Griffith, a pediatrician with Pediatric Associates in East Providence, estimates that half the children who come to his office are truly sick. A quarter are ?worried well? ? children with slight colds that in normal times would not occasion a doctor?s visit. And the rest are folks who might have stayed home if the nurse had had time to question them more deeply about their symptoms.
Griffith has been canceling the well-child visits scheduled for the afternoon to accommodate his flu-related patients.
But the high volume is only part of the problem for pediatricians. Every visit, every conversation is also taking longer, because there is so much to explain. ?Every single phone call goes at least eight minutes,? Griffith says.
That includes conversations with families who don?t even have the flu.
Earlier this week, at East Bay Pediatrics & Adolescent Medicine in Barrington, Dr. Marcolino Ferretti spoke with a mother who brought her daughter in with a sore throat. The daughter?s illness was unrelated to flu, but the subject of flu came up anyway.
Ferretti spent several minutes explaining how the antiviral drug Tamiflu can have nasty side effects ? ranging from vomiting to psychosis ? and should only go to children at risk of getting seriously ill from flu. He explained that pediatricians are only vaccinating children younger than 5, so her school-age daughter must get the vaccine in one of the school-based clinics. ?We don?t have it,? he told her. ?We?re not getting any of that vaccine.?
?Every patient visit right now is taking an extra 5 to 10 minutes,? Ferretti said afterward.
Add to that the daunting logistics of dispensing limited supplies of vaccine, matching the type of vaccine to the child, trying to get the high-risk children vaccinated first, organizing after-hours vaccination clinics.
Ferretti said some parents have offered ?extra money? for vaccine, which he has declined.
When vaccine is not available, when Tamiflu is not advisable, most patients accept their doctors? explanations. ?If you have the time, people are remarkably understanding,? Griffith says.
But some yell and threaten. This has happened everywhere from the Hasbro clinic, serving low-income people to private offices in tony neighborhoods.
Coastal Medicine/Waterman Pediatrics sent a mass e-mail to parents asking for an end to ?the abuse of our staff by frustrated parents.? The e-mail noted that the doctors and their children were waiting their turn for vaccine like everyone else, and were not getting Tamiflu when sick. ?We are treating our families the same way we are treating your families,? the e-mail said.
Indeed, the doctors, nurses and office staff caring for sick children haven?t been able to get vaccinated themselves, because vaccine is going first to pregnant women and children. Some offices have been further strained when doctors and staff had to stay home sick.
At the East Bay health center, no one has come down with the flu ?? yet.
?What do we do when we get sick? We all feel a little bit scared about this,? said Fessler, the medical director. ?If we get stuck for staff, there?s not going to be a big pool of people to draw in.?
Despite the stresses, all the doctors interviewed said they were coping well, and praised their staff for working extra hours without complaint.
Ullman, of Aquidneck Medical Associates, describes a day that started at 8 a.m. and ended at 9:15 p.m., with meals brought in. ?They were still smiling at the end of the day,? she said of her staff.
?People are really pulling together and doing what needs to be done,? said Ferretti. ?We?re getting through it. We?re not in panic mode.?
Sarah Fessler checks the newspaper every day to see which schools are holding vaccination clinics, taking comfort each time a school in her office?s neighborhood is listed. ?Every day that goes by, more kids are vaccinated,? she said.
When it?s all over, Fessler said, ?I hope we look back and say, ?That wasn?t so bad.? ?
10:31 AM EST on Thursday, November 12, 2009
By Felice J. Freyer
Journal Medical Writer
Dr. Marcolino Ferretti of East Bay Pediatrics & Adolescent Medicine in Barrington examines Jordyn Raftery as her mom, Lisa Raftery, of Lincoln, looks on. Jordyn was sent home from school with a fever and cough and her mom was worried she had swine flu. The Providence Journal / John Freidah <!--
Susan Ginn, of East Providence, has her infant son Gabriel receive the H1N1 vaccine at East Bay Pediatrics & Adolescent Medicine.--><!--
--><!--
Kathy Baldwin, of Warren, takes her son 15-month-old son Dylan in to see Dr. Marcolino Ferretti this week.The Providence Journal / John Freidah
-->
These days the doctors who care for children work into the evening and through the weekends. They take faxes and mail from patients who could not penetrate the overloaded phone lines.
To parent after parent, they explain why they can?t do a flu test, why they won?t prescribe Tamiflu, why they?re still waiting for vaccine. They try to separate the sick from the well in packed waiting rooms. They dispense advice, reassurance and face masks ?? but no cure.
In a few instances, they deflect insults, threats and even bribes.
All in all, the pediatricians of Rhode Island have never seen anything like this.
The swine flu epidemic has exploded, more than any other place, in the offices of pediatricians and family doctors ? bringing a time- and emotion-sapping convergence of sickness, fear, demand for vaccine and need for information.
?I feel like I ran a marathon and got hit by a truck,? said Dr. Jacques Benun, a pediatrician at the primary-care clinic at Hasbro Children?s Hospital, adding that his exhaustion was more mental than physical. ?I?ve never worked this hard in my life.?
?The volume is insane,? Benun adds. ?Just so you get an idea, on Friday we saw 196 patients in eight hours? ?? double the usual number.
Most of the children seeking care are not very sick, because swine flu is a relatively mild infection. Some aren?t sick at all. ?They come in, just in case, because they?re worried,? Benun said. ?There?s this fear that there?s going to be death.?
In fact, there has been death. After two 12-year-old girls died of swine flu within a week, pediatricians saw the volume of calls soar.
In a typical year, one or two Rhode Island children die of the flu, but those deaths attract little notice. The death rate from swine flu is about the same as for seasonal flu, possibly lower, with less than 1 percent succumbing. But with many more kids getting sick, the number of deaths may be higher. And each one gets reported in the media.
When parents are concerned, pediatricians want to see the child. But the publicity about swine flu has heightened concern ? among both doctors and patients.
?Everyone is frightened,? Dr. Martha A. Ullman, a pediatrician with Aquidneck Medical Associates in Newport, wrote in an e-mail. ?With two deaths in this small state everyone wonders who is next. I have told a few that I, too, am frightened. Just enough to be very careful. So we screen each child carefully and make the best decisions we can.?
At the health center at East Bay Community Action in East Providence, the staff has already had a patient die from swine flu ? an adult. The 49-year-old Riverside woman who died on Nov. 2 had been a patient at the center, which treats both children and adults.
?We?re all affected by [the deaths]. We?re devastated to lose a patient to H1N1,? said Dr. Sarah J. Fessler, the family doctor who is the center?s medical director. ?We bring them in if people are concerned. We?ve had a low threshold for people coming in.?
Dr. Bob Griffith, a pediatrician with Pediatric Associates in East Providence, estimates that half the children who come to his office are truly sick. A quarter are ?worried well? ? children with slight colds that in normal times would not occasion a doctor?s visit. And the rest are folks who might have stayed home if the nurse had had time to question them more deeply about their symptoms.
Griffith has been canceling the well-child visits scheduled for the afternoon to accommodate his flu-related patients.
But the high volume is only part of the problem for pediatricians. Every visit, every conversation is also taking longer, because there is so much to explain. ?Every single phone call goes at least eight minutes,? Griffith says.
That includes conversations with families who don?t even have the flu.
Earlier this week, at East Bay Pediatrics & Adolescent Medicine in Barrington, Dr. Marcolino Ferretti spoke with a mother who brought her daughter in with a sore throat. The daughter?s illness was unrelated to flu, but the subject of flu came up anyway.
Ferretti spent several minutes explaining how the antiviral drug Tamiflu can have nasty side effects ? ranging from vomiting to psychosis ? and should only go to children at risk of getting seriously ill from flu. He explained that pediatricians are only vaccinating children younger than 5, so her school-age daughter must get the vaccine in one of the school-based clinics. ?We don?t have it,? he told her. ?We?re not getting any of that vaccine.?
?Every patient visit right now is taking an extra 5 to 10 minutes,? Ferretti said afterward.
Add to that the daunting logistics of dispensing limited supplies of vaccine, matching the type of vaccine to the child, trying to get the high-risk children vaccinated first, organizing after-hours vaccination clinics.
Ferretti said some parents have offered ?extra money? for vaccine, which he has declined.
When vaccine is not available, when Tamiflu is not advisable, most patients accept their doctors? explanations. ?If you have the time, people are remarkably understanding,? Griffith says.
But some yell and threaten. This has happened everywhere from the Hasbro clinic, serving low-income people to private offices in tony neighborhoods.
Coastal Medicine/Waterman Pediatrics sent a mass e-mail to parents asking for an end to ?the abuse of our staff by frustrated parents.? The e-mail noted that the doctors and their children were waiting their turn for vaccine like everyone else, and were not getting Tamiflu when sick. ?We are treating our families the same way we are treating your families,? the e-mail said.
Indeed, the doctors, nurses and office staff caring for sick children haven?t been able to get vaccinated themselves, because vaccine is going first to pregnant women and children. Some offices have been further strained when doctors and staff had to stay home sick.
At the East Bay health center, no one has come down with the flu ?? yet.
?What do we do when we get sick? We all feel a little bit scared about this,? said Fessler, the medical director. ?If we get stuck for staff, there?s not going to be a big pool of people to draw in.?
Despite the stresses, all the doctors interviewed said they were coping well, and praised their staff for working extra hours without complaint.
Ullman, of Aquidneck Medical Associates, describes a day that started at 8 a.m. and ended at 9:15 p.m., with meals brought in. ?They were still smiling at the end of the day,? she said of her staff.
?People are really pulling together and doing what needs to be done,? said Ferretti. ?We?re getting through it. We?re not in panic mode.?
Sarah Fessler checks the newspaper every day to see which schools are holding vaccination clinics, taking comfort each time a school in her office?s neighborhood is listed. ?Every day that goes by, more kids are vaccinated,? she said.
When it?s all over, Fessler said, ?I hope we look back and say, ?That wasn?t so bad.? ?
