In a recent clinic session, I was faced with a familiar dilemma about how much of my own experiences as a wife, mother, and human being to share with my patients.
My first patient of the afternoon was a 2-week-old little girl. Things were going great at home, but her parents had some questions about H1N1 vaccination. Since the little girl’s mom was a patient at our clinic, we vaccinated her to protect her daughter. However, the little girl’s dad was not our patient, so I explained that he would need to contact his own doctor to receive an H1N1 vaccination. My little patient’s father looked at me with an expression like “hey, c’mon.”
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I told him that my own husband (the primary caregiver for our 4-month-old son) had not been vaccinated either since his family physician did not have a supply of H1N1 vaccine yet. I don’t know if my patient’s father felt any better about leaving the clinic unimmunized, but hopefully he respected that I was following the rules for my own family.
A second patient also had an H1N1 concern. She has a 3-month-old daughter at home and was coming in to start contraception. The medical assistant offered her H1N1 vaccination but my patient refused, citing the recent appearance of an H1N1 expert on Good Morning America who stated that he would not get the vaccine himself or give it to his kids.
While I was performing her exam, I gently re-introduced the idea of H1N1 vaccination. “I haven’t heard about any experts opposing the vaccine,” I started, “but I can give it my strongest endorsement by telling you that I received my vaccine and will get my kids vaccinated as soon as it is available to them.” We went on to discuss live versus inactivated vaccine, and she elected to receive the same vaccine I received, as she knew that I was also a mom who is breastfeeding a young baby.
My final patient of the afternoon struggles with multiple medical problems. He and his wife are considering starting a family. After congratulating me on the recent addition to my family, he asked, “Can I ask you a personal question?”
“Sure”, I replied.
“How old are you?”
“Thirty-six,” I responded. He was reassured that I was close to his age and still able to get pregnant. He went on to ask me how I was able to lose my baby weight. I shared my secret answer: “Genetics,” I said. “Both my parents are pretty thin and I was lucky to inherit the right genes.”
I struggle at times with how much of my personal information to share with patients. While I often look for scientifically rigorous answers, I recognize that personal stories or experiences often carry more weight with my patients. I also assume – rightly or wrongly – that I have added credibility when I am able to give both the “doctor” answer and the “mom” answer.
Jennifer Frank, MD, FAAFP, is an assistant professor in the University of Wisconsin Department of Family Medicine and a faculty family physician at the Fox Valley Family Medicine Residency Program in Appleton, Wis. She is a mother of four, whose husband, also a physician, is a stay-at-home dad.
Showing posts with label flu. Show all posts
Showing posts with label flu. Show all posts
Tuesday, November 17, 2009
Thursday, November 12, 2009
Open-access scheduling for flu season
With patients flooding your office with calls or appointments this flu season, you may be considering reworking your appointment scheduling.
“Practices must be ready to accommodate the influx of patients,” consultant Nick Fabrizio told me in a recent podcast on preparing for the H1N1 virus. Fabrizio suggested practices consider a modified open-access scheduling plan, where they set aside 10 percent or 20 percent of the appointments each day for same-day acute patients.
Read more
Open-access scheduling can ease some of the pains of trying to squeeze acute patients in — on top of your normal daily load. But it takes planning, and HealthLeaders Media recently laid out six steps to open access scheduling that I thought would be helpful. Here are a few:
1. Do what is right for your practice. Keep a log of the kinds of calls and appointments being requested, so you can get an idea of how many you should set aside.
2. Be flexible, but resist the urge to fill those dedicated slots with appointments that aren’t same-day.
3. Monitor your success by checking in with staff and seeing if there are any patient complaints. Problems? Just adjust it.
You should also consider calculating your appointment schedule fill rate each month, aiming for an optimal percentage of 90 to 95. For more on open-access scheduling and more tips, check out the Physicians Practice story on the topic.
“Practices must be ready to accommodate the influx of patients,” consultant Nick Fabrizio told me in a recent podcast on preparing for the H1N1 virus. Fabrizio suggested practices consider a modified open-access scheduling plan, where they set aside 10 percent or 20 percent of the appointments each day for same-day acute patients.
Read more
Open-access scheduling can ease some of the pains of trying to squeeze acute patients in — on top of your normal daily load. But it takes planning, and HealthLeaders Media recently laid out six steps to open access scheduling that I thought would be helpful. Here are a few:
1. Do what is right for your practice. Keep a log of the kinds of calls and appointments being requested, so you can get an idea of how many you should set aside.
2. Be flexible, but resist the urge to fill those dedicated slots with appointments that aren’t same-day.
3. Monitor your success by checking in with staff and seeing if there are any patient complaints. Problems? Just adjust it.
You should also consider calculating your appointment schedule fill rate each month, aiming for an optimal percentage of 90 to 95. For more on open-access scheduling and more tips, check out the Physicians Practice story on the topic.
Tuesday, November 10, 2009
Jennifer Frank, MD: What to do about Tamiflu?
We have a young baby at home and as H1N1 started popping up in clinic and in the school system, I cautioned my older children strongly about being extra careful with hand washing before touching their baby brother.
When my husband started complaining of a headache and cough, I insisted he check his temperature. The ear thermometer read 101. “Does this thing really work?” he asked me. I felt pretty confident that he had a fever, having already done the more specific “mom test” of a hand against his forehead. “Yes,” I replied. “You’re sick.”
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My family members almost always develop illnesses and sustain injuries in the evening hours. This was no exception, and I started working my way through the phone triaging system of our family doctor, trying to get a prescription for Tamiflu for our young baby, as I was concerned that my husband was in the early throes of H1N1 influenza.
While waiting for first the nurse and then the doctor to call me back, I checked my young son’s temperature, encouraged my husband to take Tylenol, segregated my other kids in the playroom, and read up on the latest from the CDC. I debated just calling in the Tamiflu myself. However, the more I thought about it and read the emergency use authorization in children younger than 1 year, I started feeling less confident. Maybe my husband had something else going on. Should I expose my son to a potentially harmful medication if I wasn’t sure that he was exposed to H1N1? How many times would I be putting him on Tamiflu this fall and winter if we considered every febrile illness in our family (of which there are usually many) H1N1?
After several frustrating minutes spent discussing feedings and wet diapers with the triage nurse, I pulled out my doctor card. “Listen, I’m a family physician and I’m pretty sure my son has been exposed to H1N1. I think he needs Tamiflu.”
“Oh,” she replied, “I’ll page the doctor on call right away.”
The on-call doctor was busy juggling an evening clinic with my phone call and admitted that she wanted to look up the latest CDC recommendations and speak with a pediatric hospitalist before prescribing the Tamiflu for my son. I watched the clock, trying to judge how long I could wait until our local pharmacy closed for the evening. The on-call doctor called me back about 45 minutes later. “I’m sorry, when we talked before, I didn’t realize you were a physician. You probably know what I am going to tell you, but this is what I found out.”
She went on to describe the pros and cons of chemoprophylaxis in our particular situation and some of the different ways we could approach the situation. She also acknowledged her own struggle with the Tamiflu issue in her home after one of her children became ill. It was a good conversation and put me at ease as I realized that there was no clear-cut answer, but rather a variety of choices we could make to try to keep my son healthy.
I picked up the Tamiflu that night but held off on giving it to him until my husband’s illness declared itself and our oldest son developed a clear case of influenza. I was glad that I had not made a medical decision on my own but also pleased that I had an opportunity to problem solve with a colleague who respected my role as both a doctor and a mom.
Jennifer Frank, MD, FAAFP, is an assistant professor in the University of Wisconsin Department of Family Medicine and a faculty family physician at the Fox Valley Family Medicine Residency Program in Appleton, Wis. She is a mother of four, whose husband, also a physician, is a stay-at-home dad.
When my husband started complaining of a headache and cough, I insisted he check his temperature. The ear thermometer read 101. “Does this thing really work?” he asked me. I felt pretty confident that he had a fever, having already done the more specific “mom test” of a hand against his forehead. “Yes,” I replied. “You’re sick.”
Read more
My family members almost always develop illnesses and sustain injuries in the evening hours. This was no exception, and I started working my way through the phone triaging system of our family doctor, trying to get a prescription for Tamiflu for our young baby, as I was concerned that my husband was in the early throes of H1N1 influenza.
While waiting for first the nurse and then the doctor to call me back, I checked my young son’s temperature, encouraged my husband to take Tylenol, segregated my other kids in the playroom, and read up on the latest from the CDC. I debated just calling in the Tamiflu myself. However, the more I thought about it and read the emergency use authorization in children younger than 1 year, I started feeling less confident. Maybe my husband had something else going on. Should I expose my son to a potentially harmful medication if I wasn’t sure that he was exposed to H1N1? How many times would I be putting him on Tamiflu this fall and winter if we considered every febrile illness in our family (of which there are usually many) H1N1?
After several frustrating minutes spent discussing feedings and wet diapers with the triage nurse, I pulled out my doctor card. “Listen, I’m a family physician and I’m pretty sure my son has been exposed to H1N1. I think he needs Tamiflu.”
“Oh,” she replied, “I’ll page the doctor on call right away.”
The on-call doctor was busy juggling an evening clinic with my phone call and admitted that she wanted to look up the latest CDC recommendations and speak with a pediatric hospitalist before prescribing the Tamiflu for my son. I watched the clock, trying to judge how long I could wait until our local pharmacy closed for the evening. The on-call doctor called me back about 45 minutes later. “I’m sorry, when we talked before, I didn’t realize you were a physician. You probably know what I am going to tell you, but this is what I found out.”
She went on to describe the pros and cons of chemoprophylaxis in our particular situation and some of the different ways we could approach the situation. She also acknowledged her own struggle with the Tamiflu issue in her home after one of her children became ill. It was a good conversation and put me at ease as I realized that there was no clear-cut answer, but rather a variety of choices we could make to try to keep my son healthy.
I picked up the Tamiflu that night but held off on giving it to him until my husband’s illness declared itself and our oldest son developed a clear case of influenza. I was glad that I had not made a medical decision on my own but also pleased that I had an opportunity to problem solve with a colleague who respected my role as both a doctor and a mom.
Jennifer Frank, MD, FAAFP, is an assistant professor in the University of Wisconsin Department of Family Medicine and a faculty family physician at the Fox Valley Family Medicine Residency Program in Appleton, Wis. She is a mother of four, whose husband, also a physician, is a stay-at-home dad.
Wednesday, November 4, 2009
Gerald O'Malley, DO: Why I'm Not Getting the Flu Shot
I’m not getting immunized against the flu. I’m not immunizing my kids either. Sue me.
I’m not a Luddite – I know the science, and I know the statistics, and I know the professional recommendations. My kids have been fully immunized against measles, mumps, rubella, diptheria, varicella, tetanus, and all the other typical childhood diseases. I can explain some of the technical aspects of vaccine preparation. I’m still not snorting the vapor or taking the shot.
Read more
Call it stubborn or call it stupid – I don’t care. I know that there are a lot of physicians that agree with me, but they are afraid that if they refuse the vaccine they will be labeled paranoid or a conspiracy theorist, or they simply don’t want to stand out or be seen as a problem employee or be ridiculed.
I’ve had to sign attestation statements for several of the hospitals in which I work explaining why I’m refusing the flu vaccine. My home base hospital grants me the right to decline the vaccine provided I give them an explanation. The reasoning isn’t terribly important – just so long as they have some kind explanation for the refusal. The last few explanations have implicated the worldwide vaccine-industrial complex and global warming as reasons for my refusal. They don’t seem to care too much.
Some hospitals, on the other hand, care a lot about the reasons why I don’t want to vaccinate myself or my kids. In my opinion, the administrators at some hospitals are intrusive, obnoxious, coercive, and bullying in their insistence that I accept the vaccine. I do a lot of consulting work through the Philadelphia Poison Control Center, and at least one hospital has insisted that since I am a consultant member of the medical staff, I show proof of vaccination or lose medical staff privileges and face being reported to the National Practitioner database. I’ve explained that all my patient interactions involve telephone consults and I never actually set foot in the hospital, and that despite the virulence and general scariness of H1N1, I’m pretty sure that you can’t transmit it over the phone. So far, the secretaries in the medical staff office have granted me an exemption, but I’m pretty sure that when the actual administrators get around to evaluating my telephone – transmission explanation, I’ll be on the receiving end of some e-mail nastygrams.
All this attention on vaccines seems a little forced and staged, doesn’t it? How did the human race survive and prosper for centuries without absorbing a $30 vaccine every year? Is it me, or does anyone else get the distinct impression that someone is making huge bank on this flu hysteria and the concomitant insistence on mandatory vaccinations for everyone?
OK – this year we need to take two different vaccines. What about next year? Will we be required to take three? When will this end?
My colleagues that actually work at the 100 percent mandatory vaccination hospital tell me that their ED census has exploded, the waiting times have tripled, and everyone is frazzled. Would it be worse if there wasn't mandatory vaccination? It's impossible to prove a negative, but I can't imagine that it would be. At my hospital, we don't have mandatory vaccination and the patients are spilling out into the street from the waiting room. Most of them go home. Most of them don't need to be there in the first place. I worked last Thursday and overnight Saturday night and last night and probably 90 percent of the patients I saw had the flu. I think I put two pregnant women on Tamiflu, and the rest went home with Tylenol and orders to rest and drink fluids. Nobody was admitted. The overwhelming majority of patients that I see with the flu (and they ALL have H1N1, according to our ID guy) do perfectly well with supportive care.
How did we get here? Why do doctors beat up on each other to the degree that we do when the external forces decreasing access to care (lawyers, reimbursement, bureaucracy, paperwork) are so oppressive?
I’ve heard all the arguments about how mandatory vaccination is a public health issue, but so is access to care and nobody seems to care a bit about improving that, especially not in Pennsylvania, where we have seen 17 maternity units and 40 healthcare delivery centers close in the past decade, all under the watchful eye of Governor Ed Rendell. In 1992, approximately 60 percent of graduating residents stayed in this state to practice; in 2008 only 20 percent stayed. That is the public health issue that nobody seems interested in talking about.
It’s easier to manipulate a doctor’s conscience and inherent sense of moral goodness (and if that doesn’t work, threaten and coerce) to try to achieve vaccination compliance than it is to lobby the corrupt state and federal legislature to provide the resources to actually deliver health care.
Instead of focusing on me and my declination of the vaccine, why don’t our professional leaders ignore the low-hanging publicity fruit and tackle the hard job of taking the fight to the legislators and improving access to care?
My daughter is home right now. She has H1N1 and has been home since Saturday with fevers and coughing. Forty percent of her school is out sick, and my wife just called to tell me that our son is in the nurses office with a fever, so I guess he will be laid up for the rest of the week. Then he will get better and go back to school and life will return to normal in a few days. My daughter is already over the worst of it and should be back to school tomorrow. Thankfully, my kids’ pediatrician has been in practice almost 40 years and he doesn’t see the need to vaccinate all his patients. At least I won’t need to come up with a creative explanation for him.
I’m not a Luddite – I know the science, and I know the statistics, and I know the professional recommendations. My kids have been fully immunized against measles, mumps, rubella, diptheria, varicella, tetanus, and all the other typical childhood diseases. I can explain some of the technical aspects of vaccine preparation. I’m still not snorting the vapor or taking the shot.
Read more
Call it stubborn or call it stupid – I don’t care. I know that there are a lot of physicians that agree with me, but they are afraid that if they refuse the vaccine they will be labeled paranoid or a conspiracy theorist, or they simply don’t want to stand out or be seen as a problem employee or be ridiculed.
I’ve had to sign attestation statements for several of the hospitals in which I work explaining why I’m refusing the flu vaccine. My home base hospital grants me the right to decline the vaccine provided I give them an explanation. The reasoning isn’t terribly important – just so long as they have some kind explanation for the refusal. The last few explanations have implicated the worldwide vaccine-industrial complex and global warming as reasons for my refusal. They don’t seem to care too much.
Some hospitals, on the other hand, care a lot about the reasons why I don’t want to vaccinate myself or my kids. In my opinion, the administrators at some hospitals are intrusive, obnoxious, coercive, and bullying in their insistence that I accept the vaccine. I do a lot of consulting work through the Philadelphia Poison Control Center, and at least one hospital has insisted that since I am a consultant member of the medical staff, I show proof of vaccination or lose medical staff privileges and face being reported to the National Practitioner database. I’ve explained that all my patient interactions involve telephone consults and I never actually set foot in the hospital, and that despite the virulence and general scariness of H1N1, I’m pretty sure that you can’t transmit it over the phone. So far, the secretaries in the medical staff office have granted me an exemption, but I’m pretty sure that when the actual administrators get around to evaluating my telephone – transmission explanation, I’ll be on the receiving end of some e-mail nastygrams.
All this attention on vaccines seems a little forced and staged, doesn’t it? How did the human race survive and prosper for centuries without absorbing a $30 vaccine every year? Is it me, or does anyone else get the distinct impression that someone is making huge bank on this flu hysteria and the concomitant insistence on mandatory vaccinations for everyone?
OK – this year we need to take two different vaccines. What about next year? Will we be required to take three? When will this end?
My colleagues that actually work at the 100 percent mandatory vaccination hospital tell me that their ED census has exploded, the waiting times have tripled, and everyone is frazzled. Would it be worse if there wasn't mandatory vaccination? It's impossible to prove a negative, but I can't imagine that it would be. At my hospital, we don't have mandatory vaccination and the patients are spilling out into the street from the waiting room. Most of them go home. Most of them don't need to be there in the first place. I worked last Thursday and overnight Saturday night and last night and probably 90 percent of the patients I saw had the flu. I think I put two pregnant women on Tamiflu, and the rest went home with Tylenol and orders to rest and drink fluids. Nobody was admitted. The overwhelming majority of patients that I see with the flu (and they ALL have H1N1, according to our ID guy) do perfectly well with supportive care.
How did we get here? Why do doctors beat up on each other to the degree that we do when the external forces decreasing access to care (lawyers, reimbursement, bureaucracy, paperwork) are so oppressive?
I’ve heard all the arguments about how mandatory vaccination is a public health issue, but so is access to care and nobody seems to care a bit about improving that, especially not in Pennsylvania, where we have seen 17 maternity units and 40 healthcare delivery centers close in the past decade, all under the watchful eye of Governor Ed Rendell. In 1992, approximately 60 percent of graduating residents stayed in this state to practice; in 2008 only 20 percent stayed. That is the public health issue that nobody seems interested in talking about.
It’s easier to manipulate a doctor’s conscience and inherent sense of moral goodness (and if that doesn’t work, threaten and coerce) to try to achieve vaccination compliance than it is to lobby the corrupt state and federal legislature to provide the resources to actually deliver health care.
Instead of focusing on me and my declination of the vaccine, why don’t our professional leaders ignore the low-hanging publicity fruit and tackle the hard job of taking the fight to the legislators and improving access to care?
My daughter is home right now. She has H1N1 and has been home since Saturday with fevers and coughing. Forty percent of her school is out sick, and my wife just called to tell me that our son is in the nurses office with a fever, so I guess he will be laid up for the rest of the week. Then he will get better and go back to school and life will return to normal in a few days. My daughter is already over the worst of it and should be back to school tomorrow. Thankfully, my kids’ pediatrician has been in practice almost 40 years and he doesn’t see the need to vaccinate all his patients. At least I won’t need to come up with a creative explanation for him.
Thursday, October 22, 2009
More H1N1 help
In an effort to improve the coordination of care this flu season, the AMA has launched a Web site (www.amafluhelp.org) they are calling the “nation’s first comprehensive Web-based patient flu health-assessment program.”
The idea is patients can assess the severity of their symptoms, and share their information online with their provider (both must register to use the system). There are also tools for physicians to help them monitor their patients’ symptoms, facilitate treatment, and manage the practice’s work flow. (The site is free, but physicians may decide to charge patients for online monitoring.)
The last part – managing the influx of patients this flu season – was the topic of this month’s podcast. And if you haven't already seen it, check out our H1N1 resource page.
The idea is patients can assess the severity of their symptoms, and share their information online with their provider (both must register to use the system). There are also tools for physicians to help them monitor their patients’ symptoms, facilitate treatment, and manage the practice’s work flow. (The site is free, but physicians may decide to charge patients for online monitoring.)
The last part – managing the influx of patients this flu season – was the topic of this month’s podcast. And if you haven't already seen it, check out our H1N1 resource page.
Friday, October 9, 2009
H1N1 resources for your practice
As flu season gets underway, your practice will be on the front lines of the outbreak. Are you ready?
To help you prepare, we've developed an H1N1 flu resource page with information and links. Now is the time to develop a plan to handle an influx of patients and possibly a diminished staff.
To help you prepare, we've developed an H1N1 flu resource page with information and links. Now is the time to develop a plan to handle an influx of patients and possibly a diminished staff.
Are you getting a flu shot?
Do you plan to get the flu shot? How about the H1N1 vaccine?
Considering the hype around getting the vaccine distributed and readying your practice for the flu onslaught, it surprised me that most health care workers likely won’t be getting vaccinated themselves.
So should it mandatory?
Read more
Historically only 40 percent of healthcare workers get vaccinated from the seasonal flu. Why? Perhaps it’s many of the same reasons the general public hesitates. Maybe they are skeptical the vaccine will work, or they are convinced they won’t get sick.
Now, many hospitals and healthcare organizations are mandating the flu vaccine. New York State is requiring it, and large hospital chains like the Hospital Corp. of America, MedStar Health, and the UC Davis Health System are mandating it, according to NPR. Here's a pretty strongly-worded opinion in favor of mandatory vaccinations for healthcare workers.
Opponents of the requirement say it’s infringing on their rights.
But what is the hesitation? Wouldn’t it make sense to keep yourself flu-free and avoid spreading it to patients? Should it be required?
And are you planning on getting the flu shot? Why or why not?
Considering the hype around getting the vaccine distributed and readying your practice for the flu onslaught, it surprised me that most health care workers likely won’t be getting vaccinated themselves.
So should it mandatory?
Read more
Historically only 40 percent of healthcare workers get vaccinated from the seasonal flu. Why? Perhaps it’s many of the same reasons the general public hesitates. Maybe they are skeptical the vaccine will work, or they are convinced they won’t get sick.
Now, many hospitals and healthcare organizations are mandating the flu vaccine. New York State is requiring it, and large hospital chains like the Hospital Corp. of America, MedStar Health, and the UC Davis Health System are mandating it, according to NPR. Here's a pretty strongly-worded opinion in favor of mandatory vaccinations for healthcare workers.
Opponents of the requirement say it’s infringing on their rights.
But what is the hesitation? Wouldn’t it make sense to keep yourself flu-free and avoid spreading it to patients? Should it be required?
And are you planning on getting the flu shot? Why or why not?
Thursday, October 1, 2009
Podcast: H1N1 prep
Are you ready for flu season?
Many practices can likely expect an influx of patients either calling with concerns about the H1N1 virus or showing up for appointments with flu symptoms. Then there’s the possibility of staff getting ill, further taxing the practice’s day-to-day operations.
So now’s the time to prepare. Is your staff cross-trained to handle all the duties? Do you have a scheduling plan to handle the extra appointments?
For this month’s podcast, I spoke with consultant Nick Fabrizio about what practices should be doing to prepare for flu season. Have a listen, and tell us here what you are doing to get ready.
Many practices can likely expect an influx of patients either calling with concerns about the H1N1 virus or showing up for appointments with flu symptoms. Then there’s the possibility of staff getting ill, further taxing the practice’s day-to-day operations.
So now’s the time to prepare. Is your staff cross-trained to handle all the duties? Do you have a scheduling plan to handle the extra appointments?
For this month’s podcast, I spoke with consultant Nick Fabrizio about what practices should be doing to prepare for flu season. Have a listen, and tell us here what you are doing to get ready.
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