GP flu diary: know your symptoms
Updated on 22 August 2009
In a week which has seen a remarkable drop in the number of cases of potential swine flu, GPs are beginning to cope with other issues, writes Dr Peter Stott.
Readers of this blog will recognise that I have a particular worry that Tamiflu is being used inappropriately. We have made antivirals far too easily available for what is mostly a mild infection. I also have concerns that the national flu line is not always giving patients appropriate advice. One case this week stands out.
On Wednesday, there was a call to our telephone clinic. It was from a middle-aged lady who had called the national flu-line earlier that day.
"I told them I had started coughing up green phlegm on Monday," she said. "I felt unwell and was worried because I have asthma and have had pneumonia before. The person on the flu-line asked me if I had a temperature. When I said no, he said, 'Never mind, we'll put you down as having one.' Then he said 'and we'll put you down as being confused as well. That means you have four symptoms and need Tamiflu.'"
At this my patient said she had protested but the person on the flu-line had already issued her a code number, given her the address of a local pharmacy and asked her to send a buddy to collect the drug. When she protested again that she did not want Tamiflu, the flu-line advised her to contact her GP, which she did.
So here we have a lady who was coughing up green phlegm and possibly has a chest infection. She had asthma and a history of pneumonia which puts her at risk. She does not have the typical symptoms of swine flu; and even if she did, she is at day three of the illness - too late for antivirals to offer any benefit.
There were a lot more questions that she should have been asked. Was she wheezy? Did she have chest pains when she breathed? Was there any blood in her phlegm? How serious was the last episode of 'pneumonia'?
The symptoms of swine flu are identical to the early stages of very many other illnesses - other virus infections, chest infections, tonsillitis, even meningitis and septicaemia. Telling the difference between all of these is not easy.Dr Peter Stott
Why was someone like this prescribed Tamiflu? It was inappropriate, would have promoted a false sense of security, and could have led her to miss the signs of a more serious illness.
I recognise that it must be mind-numbing for these flu-line telephone operators talking to thousands of people all day long about the same thing, following the same rigmarole of tedious questions. I have taken this sort of call myself and recognise that they must come under a lot of pressure to issue a prescription.
But on the other hand, they do have a duty to do their job efficiently and to work to the agreed process; not simply assume every caller has just rung up to get some Tamiflu and is going to give them a bad time if they don't give them some.
What they should be doing is trying to identify which patients have swine flu, which are most ill and at a stage of the illnesses when they need Tamiflu, which people are most of risk of complications, and directing appropriate cases to their GP.
The symptoms of swine flu are identical to the early stages of very many other illnesses - other virus infections, chest infections, tonsillitis, even meningitis and septicaemia. Telling the difference between all of these is not easy. I know because I have been doing it for over 30 years.
Most of the callers to the flu-line will have trivial illnesses and not need special treatment. What this service should be doing is selecting out the cases which are more serious and need anti-virals and directing those who are not typical or who have complications to their GP. I have concerns that unless this is carried out correctly, eventually something serious will be missed.
This lady did not have anything more than an ordinary upper respiratory tract infection, but she did have a problem which merited antibiotics rather than antivirals.
The flu line should have recognised this and directed her to the GP. Fortunately, she had enough insight to recognise that for herself.
Dr Peter Stott is a GP at the Tadworth Medical Centre in Surrey.
