Another letter from 16-Jun from PH advising of the move from no swabs
to swabs and only treating confirmed.  States:

"...early clinical symptoms for swine flu can make it difficult to
distinguish between this condition and other very mild self-limiting
conditions.  Therefore I would ask you to bear these facts in mind
when you are considering referring patients to the antiviral
distribution centres.  I would suggest that patients should have a
clear history of continuing fever, *and* two or more symptoms from the
following list: cough, sore throat, headache, rhinorrhoea or limb /
joint pain'.

Surely the problem is the sensitivity of these screening criteria?
Can we accept making these tighter and thus having a larger number of
false negatives?  At present only 8% of swabs locally have tested
positive.

I see nothing in the advice above that will reduce the swabbing rate
although they have removed diarrhoea from the diagnostic criteria, I
think, when earlier descriptions of the illness suggested diarrhoea
was often one of the presenting symptoms.

Again 'continuing fever' is hard to define and indeed to establish from history.

The problem with giving us such firm guidance is that we feel
compelled to stick to it, and thus end up referring people we may
consider to be well and the diagnosis unlikely.  I suspect for many
GPs just saying, 'If you think they have flu then refer them' would
increase the sensitivity overall, but would we then miss many mild
cases?  I am aware of several pts in whom I have considered flu
unlikely but sticking to the criteria in the algorithm they have
required treatment, and thus their whole family have required
prophylaxis.

I think I can probably diagnose influenza without an algorithm.  I
certainly used to.

I don't mean all this to be critical btw.  Well, maybe I do, but in a
helpful and constructive way :)

Quieter today flu wise.  Maybe we have seen the summer peak...

-- 
Dr Paul Miller
Tel: 07711-346-928



2009/6/18 Paul Miller <[log in to unmask]>:
> Another day another algorithm...
>
> The new thinking, as of tomorrow, is that anyone we think may have flu
> gets swabbed, but unless we need to see them for clinical reasons we
> will refer them by fax to the swabbing centre.  The swabbing centre
> will contact them within 24 hrs and advise to attend for swabs.
>
> Also, only swab positive people and their contacts will now receive
> Tamiflu.  GPs will be informed about positive swabs and asked to
> supply a GP10 for these, i.e. a prescription.  These can then be
> exchanged for the actual drugs by attending one of 3 local community
> pharmacies.
>
> So...pros and cons and we will wait and see how this impacts.
>
> At least, and I am grateful for this, we are not being required to
> swab everyone obo public health.
>
> May be some anger at not getting tamiflu until postive result, but
> maybe not.  Most people are reasonable, or at least are capable of
> being so :)
>
> Not in the surgery tomorrow. :)
> --
>
> Dr Paul Miller
> Tel: 07711-346-928
> http://visionblogged.blogspot.com
>
>
>
> 2009/6/18 Michael Leuty <[log in to unmask]>:
>> 2009/6/18 Alistair Holmes <[log in to unmask]>:
>>> I think there is an underlying assumption here that is a diagnosis is a
>>> singular phenomena. When used as a label in General Practice it seems to
>>> cover a descriptor as an aid to development of a safe management plan for a
>>> patients presentation
>>
>> Yes. The Grauniad has discovered that GPs do not always know the
>> result of a lab test without doing it. Another triumph for
>> investigative journalism.
>>
>>> I have found like my trainer described to me nnnnnn years ago as the career
>>> develops attributing Diagnostic Labels to consultations is more challenging,
>>> and the coding systems while better than nothing have the effect of
>>> observing a Turner sunrise in 4 bit colour.
>>
>> That is such a lovely analogy. Unfortunately the message has not got
>> through to Government, whose solution for everything is to create a
>> database to manage the problem.
>>
>> Mike
>>
>> --
>> Michael Leuty
>> Nottingham, UK
>>
>