Too Sick to See Patients « Family Webicine

Medical providers get sick, too. As a matter of fact, we often get sicker than the patients that we treat everyday. Our immune systems are constantly being challenged. People cough in our faces; they sneeze on us; little children whip “stuff” on us. Our immune systems work overtime when we are working. And, when germs do make it through our defense systems, we will become ill. Of course, that is happening to me right now.

A few minutes ago, I called my office to have them cancel my patients for today. I feel real bad about this, but we have other providers in the office that can see the ones that we were not able to contact. Last week, my PA wife was ill. When they called to cancel her patients, they simply informed them that she would not be in today and they would have to re-schedule. That is not enough information. Patients need to know the reason why we canceled their appointment. I told the medical assistant to tell them she was ill. People really do understand that we get sick, too, and will be much more sympathetic when they are inconvenienced.

I work 12-hour shifts and handle a large percentage of the acutely-ill people that call on the same day. Acutely-ill people are the most contagious, so it doesn’t surprise me when this happens from time to time. I don’t believe I have been sick for about a year.

So, why am I blogging? I am bored. I have a pile of tissues accumulating on my desk; I am coughing my head off, have a fever, body ache, headache, and basically, I feel like crap. I was up all last night doing the same; keeping the dogs awake. My wife decided to sleep in a different bedroom.

There is a good chance that I have influenza. I certainly saw enough laboratory-confirmed cases recently. This year’s flu vaccine did not make the cut. Every year, a new vaccine is developed, anticipating the virulent strain. This is based on the flu strain the hits the Southern hemisphere about six months prior — their flu season is opposite of ours. Most flu strains originate in China, like most of the stuff we purchase. Influenza typically comes from pigs or fowl (Pleasant, huh?), so agricultural societies that have a close, intimate relationship to these creatures are the first to get these mutated animal-to-human stains. Some years, the flu vaccine is right on, or at least the flu type was similar to a previous year. This year? Not.

Many people think they have “the flu”, but most are probably wrong. Influenza is a respiratory disease; not diarrhea and vomiting. It causes high fevers, severe coughing spasms, body aches, headaches, sore throat, malaise, loss of appetite, etc. When you have the true flu, even your hair hurts. At first, you are concerned that you may die. At the height of the illness, you start hoping that you do. Of course, death from the flu is not a laughing matter. Every year in the U.S., tens of thousands of people die from influenza and its complications. About 90 years ago, during the Spanish Flu Pandemic, about 20 million people died. Visit an old cemetery sometime and look at the dates. You will see a lot of 1918′s, involving people of all ages, including many, many children.

My first step today is to see if I have influenza or not. This requires a rapid test from a nasal swab. My wife will bring it home over lunch. If I have type A influenza, I will start Tamiflu today — an effective antiviral medication that will shorten the course and severity, allowing me to get back to work and see the other people with flu. If my test is negative, I will just wing it. Based on the generalized symptoms that I have, the most likely culprit is a viral infection. Viruses do NOT respond to antibiotics.

Tomorrow is my normal day off, so I should (hopefully) be back to work the following day. Most people with viral illnesses are contagious a day before, and about two days later. I should be fine in that respect. Since I see many newborns and well children in my practice, too, I do not want to expose them. Viral illnesses are truly the Gift that Keeps on Giving.

Today, I will just do what I can. Get plenty of rest. Drink fluids. Eat some chicken soup. Take some anti-inflammatories for these body and headache. If I try and watch TV or read, I will fall asleep. Perhaps, my body is telling me something.

These winter months are brutal in a medical practice. It seems like someone is out sick every day, and the demand for appointment always exceed the availability. We have an “open access” policy in our practice. This means that anyone who would like to be seen today; can be seen today. The patients love it. We are not so enthusiastic some days when we get home at 10 PM. When you are ill, you need to have access to your medical provider. We signed on for that job when we picked the profession. It really ruffles my wrinkles when someone posts on the WebMD ENT board, that they are sick, but their doctor can’t see them for two weeks! That’s crazy.