Swine flu: the troubles of telephone diagnosis

[Shiloh]

UK Experience:
Source: http://timesonline.typepad.com/science/2009/08/swine-flu-the-troubles-of-telephone-diagnosis.html

08/28/2009
Swine flu: the troubles of telephone diagnosis

Swine flu

GUEST POST BY DR ZARA AZIZ

Young children are at increased risk of swine flu complications, yet guidance for diagnosis remains ambiguous. Both the Health Protection Agency and Royal College of Paediatrics and Child Health are advising GP review of symptomatic infants under the age of one.

But what of older children? There are reports up and down the country of serious conditions such as meningitis, pneumonia and kidney infections being missed when children are being misdiagnosed with swine flu over the telephone.

Perhaps we should be concentrating less on headlines such as "16 year olds run the swine flu hotline" and more on the obvious fact that most doctors can often struggle to establish telephone diagnoses in sick children (with or without fever). One of the golden rules of telephone triage is to decide when and where to examine a sick child not if.

Currently Tamiflu is being issued by the Pandemic Flu Service for children over the age of 12 months if they meet certain criteria. But fever, cough and muscle pains can be manifestations of a multitude of conditions.

Many parents are not convinced that their child has swine flu and are declining to use the helpline and ringing their GP. This often leads to the child being brought in, through the back door or after hours, for an examination.

Most family doctors would advocate this safety-netting. Recently I spoke to a young mother who was concerned about her two year old daughter. The child was lethargic, coughing and felt hot though they did not have a thermometer. She had no transport and could not afford a taxi, and thought she too had swine flu. I visited them and found them both to be fairly well and did not prescribe Tamiflu.

In hindsight, the swine flu helpline was hastily engineered to combat the increasing pressures on GPs, out of hours services and hospitals. But it has inevitably led to easy acquisition of Tamiflu (with its potentially hazardous side effects) in the absence of swine flu.

This needs to be rectified particularly as most people contracting swine flu will have a mild illness. But we would be prudent to remember that for many others, including children, the diagnosis can be a serious one particularly if it blinds us to the possibility of other health conditions.

Zara Aziz is a Bristol GP

Posted by Mark Henderson on August 28, 2009 in Public Health , Swine Flu | Permalink | Post to Twitter Bookmark and Share

 

[Ronan Kelly]

Re: Swine flu: the troubles of telephone diagnosis

Here's an e-mail I received from my sister who brought her kids to a Doc in England. They had coughs for a week one had vomiting & diarrhea for a couple of days;

"Well you see I said that to him how can you say it's swine flu? It could have been anything. They've had worse colds. He said that's true and last summer he'd probably say summer cold but they have been directed by the government to diagnose those with the correct symptoms as having swine flu and issue tamiflu. He said he would have given it to me a week earlier. I said I don't think I'd have given tamiflu to the kids. He said he probably wouldn't give it to his kids either but he has to do what the government has directed.