Wednesday, 12 August 2009

Tales from the Flu Line

Today we had some instances of how well the use of medically untrained call centre operatives are having a huge impact in the phoney war that is the current swine flu “crisis”. We saw our first patient who had successfully completed his free flu Tamiflu after ringing the Swine flu line service. He had seen one of us a few days before who had made the correct diagnosis (viral upper respiratory tract infection) and they had been given the correct advice (paracetamol, fluids and it will get better on its own).

However, because all patients here in Northernshire are more qualified than their doctors, as his minor symptoms did not get better after 2 curative doses of Lemsip Max strength flu cure and it was clearly a case of severe Swine Man flu he rang the Panic line and despite a constant temperature of 37 degrees he got a box of the magic Tamiflu and an instant week off work to watch the cricket, sorry, recouperate.

So in a controlled study of one, Tamiflu does nothing as he was still coughing although slowly getting better as one would expect from a simple but very common viral upper respiratory tract infection that most GPs will be seeing at this time of year.

The widespread use of Tamiflu in such people will almost certainly accelerate the development of resistance in virus(es) due to its indiscriminate use.

The second case yesterday shows how Tamiflu seems to be given out without any consideration of other medical matters. We tell our students that before they prescribe they must always ask about allergies and also is the patient on any other medicines to prevent drug errors. A patient had rung the swine flu line and was debating whether to take Tamiflu as he was on anti epileptic drugs so rang to ask.

There is very little information on drug interactions with Tamiflu (certainly none we could find in the prescribers’ bible the British National Formulary) and the Summary of Product Characteristics thinks that interactions are unlikely. We often joke that if a drug has no side effects it doesn’t do anything so does that mean a low risk of interactions is similar?

We do not know if swine flu line operatives ask about other disease and medications or allergies but it is a bit worrying that patients are thinking to ask these questions of their doctors before taking a drug that has not be prescribed by a doctor.

Praise be to the Party for its contribution to medical science by conducting one of the largest clinical trials of a drug not being prescribed by a doctor to unseen patients over the phone. Bet they got that one past an ethics committee in a couple of days?

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