Recently overheard: “Oh, I never get the flu shot – I always get the flu from it!”

Also recently overheard: “I want to be careful about shaking hands – I might get swine flu!”

“Swine” flu has certainly got our attention! As schools go back in session for the fall (in this part of the world…), pandemic planning is kicking into high gear with contingency plans for school and work absences, plans for the H1N1 vaccine, and posters seemingly everywhere advising precautions to limit the spread of H1N1.

All this planning certainly makes sense, and represents, I think, a great example of coordination among different sectors of the public health community.

But do we really need to stop shaking hands?

Seasonal influenza has been with us for years – and people still mistake “flu” for vomiting and diarrhea (at least in our area!), still avoid the flu shot thinking it will give them the “flu,” and we still have unacceptably low uptake of flu shots in both the general population and among health-care workers.

Novel H1N1 seems to have people even more worried than they were with SARS (or moreso!), yet precautions for seasonal flu still get brushed off.

How to respond?

It’s easy enough to be irritated when people brush off longstanding health threats – while novel threats get all the attention and generate lots of worry. But the family doctor in me has to wonder, “Why?”

• What is it about human nature that makes the new and different seem so exciting or threatening, and the old seem blasé and routine?

• What is it about my communication with my patients that has us (my patient and me) STILL meaning different things when we talk about the “flu”?

• How do I respond to the patient who I think is mistakenly taking the “it can’t happen to me” view?

• How can I focus the worry about the “new” into energy to deal better with the “familiar?”

Swine flu is new – but new infectious outbreaks are not. SARS, a local Norovirus outbreak, community-acquired MRSA, etc, etc, etc.

Each new threat is vital to address, but maybe each new threat may help us as docs find ways to  understand our patients better and find those “teachable moments” we’ve been looking for – to help motivate change in dealing with the familiar.

Seasonal flu and swine flu. How can our response to one help us respond better to the other? And how can our patient’s responses to BOTH help us understand our patients better?

Right now our little town is in the grip of the swine flue pandemic. Its officially an epidemic.  The reported rate of influenza presentations in the last two weeks in the 6 practices has sky-rocketed, being about 5 times the normal seasonal rate of influenza presentation. (Its winter here)

There are many lessons that we have already learnt, with clearly significant success from the “stay at home” message for at least in our practice we are only seeing the reasonably sick patients and alas those who can't read or hear the public health messages. We haven't been overrun with patients yet....Clearly good practice and public health organisation has allowed the development of systems to cope with the high number of sick fortunately only about 1% of whom require intervention. A great practice for a more virulent epidemic.

Talking with other medical centres, it seems that good practice management is key to handling the problem, particularly focusing on barrier hygiene and isolation techniques. You have to combine this with skilled reception staff and excellent phone nurse triage but it works. 

Funny thing is that a little over a couple of months ago the idea of barrier techniques was being  laughed at by most docs including the author. That was until my practice manager and I visited a couple of practices in Toronto where the SARS epidemic had such an impact on primary care. To see practices where curtains were not used for patient privacy was a little surprising until our good host from McMaster Uni pointed out the reservoir of viruses and bacteria that such niceties provided.

This evening, at a public health meeting for all primary care, the hygiene strategy was emphasised. However the idea that we should removed curtains was laughed down as being “over the top” although I note that we were discouraged from having seats with “furry” seat covers. Now I admit that there is a significant difference between seat cover material and curtains, but I have a faint suspicion that we will come to change our views on this. History does not repeat itself, just that doctors make the same old mistakes.

Another interesting observation from the epidemic to date has been the fact that the “hard to reach” have become the most likely to suffer. The non European population, especially itinerant workers here to prune the 1000s of hectares of grapes in the valleys suffer more because of both language and also cultural problems. The former issue is blindingly obvious, but some of the social behaviour, especially “sickness behaviour” such as whole families visiting when someone becomes sick, clearly facilitates infection spread. Interestingly one important cultural group has already altered the practice of kissing greeting at meetings in response to the epidemic.

There must be other models of this type of social change out there.