Influenza Season 2012-2013

[doctorcoug]

What's the point of going to the doctor if you think you have the flu assuming you're not really young, old, or have a compromised immune system?

Unfortunately in our country, the value of a physician in the eyes of a patient is his/her ability to treat. Patients value getting an antibiotic when they have an ear infection. What they should really value is my ability to hear the history, use a good physical exam, and interpret data correctly to come up with the diagnosis. The value is not that I just diagnosed you with the flu, the value is that I recognized that you don't have the scores of other mimicking conditions and I diagnosed you with the flu.

When that is valued, then costs of healthcare will decrease because doctors will be once again be incentivized to diagnose more accurately.

via a galaxy s3 far far away

[Danimal]

The value is not that I just diagnosed you with the flu, the value is that I recognized that you don't have the scores of other mimicking conditions and I diagnosed you with the flu.

via a galaxy s3 far far away

Considering base rates of the flu vs other serious conditions I guess I just don't value that very much.

[CardiacCoug]

When that is valued, then costs of healthcare will decrease because doctors will be once again be incentivized to diagnose more accurately.

Big problem: how do you determine whether or not a patient was diagnosed accurately?

That would take another doctor to review every case. But then who could say whether the reviewing doctor or treating doctor was correct if there is disagreement? Maybe we need a panel of ten doctors to review every case and then we could see how they vote on the issue of whether or not each patient was diagnosed accurately. Not sure we could afford that, though.

Yeah I'm pretty sure there is no good way to pay doctors based on "accuracy of diagnosis."

[doctorcoug]

I went to get some relief from my symptoms (coughing).

And you probably had a good placebo effect.

via a galaxy s3 far far away

[doctorcoug]

Big problem: how do you determine whether or not a patient was diagnosed accurately?

That would take another doctor to review every case. But then who could say whether the reviewing doctor or treating doctor was correct if there is disagreement? Maybe we need a panel of ten doctors to review every case and then we could see how they vote on the issue of whether or not each patient was diagnosed accurately. Not sure we could afford that, though.

Yeah I'm pretty sure there is no good way to pay doctors based on "accuracy of diagnosis."

I was talking more from a psychological perspective from the patient.

In regards to actually doing this from a healthcare policy, increase rates for E&M codes so that all physicians are paid more to think. Provide bonuses to physicians that have low cost of care benchmarked to their indexed level of acuity (all doctors say they see really sick patients; prove it). This will be a start.

I have used your specialty as an example. Most new interns these days have no idea how to distinguish different murmurs by auscultation. In this day and age, a murmur ends up with an echo.

via a galaxy s3 far far away

[wuapinmon]

And you probably had a good placebo effect.

via a galaxy s3 far far away

Don't be an ass. The cough syrup he gave me made me feel a lot better because I was having abdominal muscle cramps from coughing so much. There's no fucking placebo effect from an opioid cough suppressant.

Do you even hear yourself sometimes? The arrogance is astounding.

[doctorcoug]

Don't be an ass. The cough syrup he gave me made me feel a lot better because I was having abdominal muscle cramps from coughing so much. There's no fucking placebo effect from an opioid cough suppressant.

Do you even hear yourself sometimes? The arrogance is astounding.

Meta-analysis shows that these cough syrups decrease symptoms no better than placebo. Maybe you were different.

via a galaxy s3 far far away

[Bo Diddley]

I've never had the flu. I don't plan on getting a shot.

You're just a carrier.

I only get sick every few years. I don't know if getting the flu shot helps me or not. The Army gives me a shot every year, but I didn't get sick very often before that either.

[doctorcoug]

Let this be a lesson...post-influenza pneumonia is often due to MRSA and it is an equal opportunity killer. Think you are young and healthy? think again. I have diagnosed a lot of flu in the last two weeks and EVERYBODY is told that if they get better, then worse that it could be a life threatening condition and to call me urgently.

Every child, teenager, and pregnant mother I've seen die from post-influenza pneumonia has had a similar course and they all were dead within 36 hours of diagnosis of post-influenza pneumonia.

Docs: Don't let a post-influenza patient die without vanc.

Flu Leads to Texas Teens' Death:

The common flu rarely kills the young and healthy, but the Schwolert family knows it can.
Their 17-year-old son Max felt ill on December 22 as the family drove to Wisconsin for Christmas vacation, beginning a series of ups and downs that would ultimately claim his life.
At first, Max took Tylenol for his symptoms: a mild fever and nausea.
He woke up the next morning feeling well enough to play in the snow with his two sisters. His family endearingly called him "Panda," for his gentle nature and 6' 4" height.
What you need to know about the flu How to avoid catching the flu
Flu picks up steam across the United States
The next day, Christmas Eve, Max stayed home with a cough while his family attended church. The extra bed rest seemed to help. By Christmas day, Max felt better again, even participating in the family festivities.
But later that night he took a turn for worse and never got better.

Max Schwolert poses with his sisters, Zoey, left, and Jazzy.
"He woke up very sick," said Tom Schwolert, Max's father.
"He had an excessive 104.9 fever, and we could not break it," said Max's mother Melanie.
The Schwolerts took their son to the local hospital where he tested positive for the flu.
The flu kills about 36,000 people a year in the United States, according to the Centers for Disease Control and Prevention, though the range varies greatly. The flu shot reduces one's chances of getting the flu by 60%.
"Within 30 minutes the doctor was like, 'Something's really wrong here. His kidneys are starting to fail. His blood pressure is really low,' " Tom remembered.
Max had to be helicoptered to Regions Hospital in St. Paul, Minnesota, but there was no room on the flight for family. Max's mother had to say good-bye to her sick son and drive separately. That "broke my heart," she said.
"He looked at me and there were some tears rolling down his face. He said 'Mom, I'm scared.' I said, 'I know buddy, I am too.' And then he saw me crying. He said, 'Mom it's going to be OK, you're going to be OK, I love you. And that's really the last coherent thing he said to me."
Max spent four days intubated in the intensive care unit at Regions. A staph bacterial infection soon led to septic shock.
By December 29, Max was dead.
When the Schwolert family returned home from Minnesota, the college acceptance letter Max had been hoping for had finally been delivered

[LiveCoug]

This week has been miserable at my house. My daughter contracted influenza B, but is doing much better now. I have something going on that has given the the worst sore throat ever. It feels like I'm swallowing razor blades. Haven't slept in 3 nights. Doctor just says it's a viral infection. Whatever.

[eldiente]

This week has been miserable at my house. My daughter contracted influenza B, but is doing much better now. I have something going on that has given the the worst sore throat ever. It feels like I'm swallowing razor blades. Haven't slept in 3 nights. Doctor just says it's a viral infection. Whatever.

stop swallowing razor blades :-) Seriously - hope you feel better soon

[jay santos]

It feels like I'm swallowing razor blades.

That's what she said.

[UtahDan]

So here is my question. I have already had the flu. I've been over it for a little over a week, though I have held on to a cough. I have been thinking of going and getting the flu shot from my pharmacist because I figure there are other strains I could still catch. My sense is that is is not too late, but do I need to wait to be over the previous flu for a little longer?

[CardiacCoug]

So here is my question. I have already had the flu. I've been over it for a little over a week, though I have held on to a cough. I have been thinking of going and getting the flu shot from my pharmacist because I figure there are other strains I could still catch. My sense is that is is not too late, but do I need to wait to be over the previous flu for a little longer?

Was the influenza diagnosis formally confirmed with a nasal swab?

If it was then you wouldn't benefit from a flu shot at this point.

If it's possible you just had a bad viral illness that was not influenza then sure you should still get a flu shot. No reason to wait.

[UtahDan]

Was the influenza diagnosis formally confirmed with a nasal swab?

If it was then you wouldn't benefit from a flu shot at this point.

If it's possible you just had a bad viral illness that was not influenza then sure you should still get a flu shot. No reason to wait.

No but SuperGabers was confirmed and I was on my ass for a week, good five days of aches, fever, abdominal pain...cough still hasn't gone away. So I'm assuming.