Archive for August 2009
Seven arguments against a doctor’s office visit for flu
1. Unless the patient has *serious* pre-existing conditions the flu will pass by itself.
2. After two days of symptoms, pharmaceutical treatments (i.e., Tamiflu or Relenza) will probably have little or no benefit.
3. The best treatment for flu in any case is to stay in bed. A trip to the doctor’s office places serious and potentially unnecessary stress on the patient and his/her immune system.
4. The patient exposes others to flu virus.
5. In principle, a prescription for Tamiflu or Relenza could be made without a physical examination. Patients can accurately take their own temperature and report their symptoms by phone.
6. The best reason for an office visit is indirect: to take a throat or nose swab/sample for flu virus confirmation, either via a rapid (immediate) test or by sending it to a lab for culturing and more accurate testing. This has public health value, because it helps track flu in the community, but does not benefit the actual patient.
7. There’s no logical reason not to sell rapid influenza test kits in pharmacies (without a prescription) and to let patients use these at home. Note that these tests have relatively low diagnostic sensitivity (50-70%): they produce many false-negative results. However the tests have diagnostic specificities of more than 90%: they produce few false-positive results; thus, if a positive result occurs, the patient probably has flu and Tamiflu or Relenza can be prescribed. This could be done by phone or fax based on a patient’s self-test. Thus, for 50-70% of patients with flu, an unnecessary and counterproductive office visit could be avoided by means of a self-administered rapid test.
The above just outline some of the obvious considerations. The main point is that this subject needs to be examined at the level of public health policy and some sensible guidelines established.
More information on flu testing: