Handling the Flu Outbreak at Our Medical Practice

For those of you in clinical practice, there is no doubt you have witnessed a peak in this year's seasonal influenza cases thus far. In my practice in Virginia, we saw a very high number of patients with influenza in mid- to late December. Fortunately for most of our patients who received the vaccine earlier in the fall, most have been spared.

The CDC estimates that this year's vaccine is at least 62 percent effective for the strains that have manifested thus far. As we do each year, an aggressive influenza vaccination program is started in early October and goes through early to mid- January. Most of our patients are well accustomed to the fact that they are able to walk in to the office and get a vaccination without having scheduled an appointment in advance. I realize that successful vaccination can significantly decrease my patients' probability of contracting the illness and we do our best to have little to no barriers in place to prevent open access.

One major problem that I am seeing in our area is the aggressive push made by pharmacies, grocery stores, department stores, etc., to provide influenza vaccines to the public. While I do not object to any of my patients receiving a vaccine at these locations, it would be my preference to provide the vaccine to them in the confines of my medical practice. Many of these locations charge a cash fee to patients for providing the vaccine. Unfortunately, many patients do not realize that most, if not all insurance carriers, allow their beneficiaries to receive the vaccine at little or no cost to the patient at all. As a way of injecting humor into the recommendation for receiving the vaccine in a medical setting I will frequently tell my patients, "...I will not try to sell you a gallon of milk. Therefore, you should not let a grocery store sell you a flu vaccine."

And then there is the topic of potential reactions to the vaccine. One of my patients received a vaccine in an airport a couple of years ago and had a reaction just after receiving it. He had to be transported by EMS to the hospital, stayed overnight in the hospital, missed his flight and as a result of his travel delays he missed several days of work. While the same patient might have had a similar reaction in my office, we are prepared to administer medications to counteract such reactions and are even able to transport the patient by wheelchair to the emergency department just down the hall. I use this example as a method of discouraging vaccination at non-medical facilities.

I will frequently recommend the vaccine to my patients, however still a good percentage of them refuse. Many of them will provide several reasons for not receiving the vaccine. However, a good portion of those patients that refused the vaccine have unfortunately received treatment in my office for influenza this season. I am hopeful that they will reconsider their decision to take the vaccine in the future.

For those patients who have contracted the virus this year, it is a painful lesson learned regarding the simple preventive measure that a single intramuscular injection could have prevented.