In message <[log in to unmask]>, Joe Gallagher
<[log in to unmask]> writes
>People once had a irrational fear of falling off the end of earth.
>People have become more sophisticated (arguable) but only the fears have
>changed. I got 10 calls this weekend worried specifically about
>Meningococcal Meningitis. Some are pressing flesh with glass slides and
>performing 24hr vigils on children. There is no outbreak in this area.
>
>Although the media are doing a good job of heightening awareness of this
>pernicious condition I fear they are making a less ideal job of keeping
>the condition in perspective. But then that doesn't make good copy.
>One health correspondent in one of our broadsheets stated. " Meningitis
>is carried at the back of the throat of a lot of people"
>I have seen one case of bacterial meningitis in 10 years. Is this
>unusually small number of cases?
>
I've seen several cases and (crosses fingers) made the diagnosis,
injected the penicillin and the patients are fine (much gratitude - good
for the ego and makes me feel I earned my money). The big problem is to
achieve a balance between vigilance and panic. Just about any child with
a febrile illness *could* be in the early stages of meningococcal
infection but very few are. If a child is alert and interested in what
is going on (over the phone I ask if they still want to watch the TV -
in the flesh I observe them), I don't think you can make the diagnosis.
I advise parents about the odds, what to watch for and emphasise that
"it looks like a straightforward self limiting illness now and the
chances are it *is* one, but if the child starts to look really ill get
back in touch". I go into to some detail about rashes, emphasise that
the headache of meningitis is far more severe than the common headache
of URTI etc and try to explore how worried the parents are, what they
really know about meningitis and the chances of catching it and so on.
You need to acknowledge their fears, place them in perspective, but give
enough information for them to act quickly "just in case". I point out
that meningitis, although rare, is unpredictable so, although it looks
nothing like it now, it can't ever be completely ruled out at that stage
of an illness.
I suspect that one of the big mistakes GPs can make is to assert
categorically "this is definitely *not* meningitis" in children with
temperature (unless it's UTI, which is another story). What's needed is
to give realistic advice about the risk and explain the limits of
diagnosis.
Toby
--
Toby Lipman 7, Collingwood Terrace, Jesmond, Newcastle upon Tyne. Tel
0191-2811060 (home), 0191-2437000 (surgery)
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