# 3586
During the the 1970’s one of the most popular medical shows on American Television was Marcus Welby, M.D.
As medicals shows went back then, it was passable entertainment, and sometimes even broached sensitive subjects not normally mentioned on TV at the time.
But with its popularity came an annoying, and potentially dangerous, side effect. Some people would watch the show (which featured one main patient/disease each week) and decide that they had the same medical problem that was highlighted on that week’s episode.
They would then show up at the hospital, or their doctor’s office, with a list of symptoms and the `news’ that they had . . Hanson’s Disease or Sydenham's chorea or some other unlikely medical malady.
One of the doctors at the ER where I worked noticed the connection, and dubbed it Marcus Welby Syndrome. I’ve no doubt that it was seen in other ERs and doctor’s offices around the country.
This illustrates the power of suggestion.
And so it should come as no surprise that, with the enormous publicity that the H1N1 swine flu has gotten over the summer, just about anyone with `flu-like symptoms’ is going to assume they have contracted this new virus.
Unfortunately a great many other illnesses can present with flu-like symptoms, particularly in their early stages. Meningitis, measles, West Nile Virus, Borreliosis, and all sorts of bacterial and viral infections can produce classic `flu-like’ symptoms.
Out of the UK tonight we are hearing of concerns over misdiagnosed patients who called the NHS swine flu Hotline.
Since potential patients and Flu hotline operators have been conditioned to `look for swine flu’, more often than not they are going to find it. Whether that is the proper diagnosis or not.
Admittedly, even doctors can (and do) miss diagnoses.
But a GP who examines a patient is far more likely to pick up on an alternative diagnosis than a hotline operator who is basically `working blind’.
First this article, then a little more discussion.
GPs fear swine flu hotline will give the wrong diagnosis
By Daniel Martin
Nine in ten family doctors fear that diagnosing swine flu over the phone means other diseases could be missed, a survey has found.
They warned that cases of tonsillitis, bronchitis and even meningitis and pneumonia could go untreated, according to the poll in GP magazine.
One said he had had to deal with a case of measles - a potentially fatal infection - which had originally been diagnosed as swine flu.
Concern has been growing over potential misdiagnoses since the establishment of a phone hotline manned by staff without medical training, which ministers are relying on to spot cases of the killer virus.
It comes as a boy with a kidney infection became severely ill after he was misdiagnosed with swine flu over the phone.
While not a scientific law like Boyle's law or Torricelli's law, the Law of Unintended Consequences can just about be counted on introduce a new complication anytime you think a new idea will `fix things’.
During a pandemic, when we are trying many new ideas, and putting programs online without having time to thoroughly test them, we can expect a fair number of these unintended consequences.
One we are watching intently for is to see whether, by handing out a lot of Tamiflu, we end up creating an antiviral resistant strain of the novel H1N1 virus. That would be a serious unintended consequence.
The NHS flu hotline has taken some of the burden off GPs by basically allowing people to diagnose themselves with the flu.
Sure, there’s a questionnaire . . . but when people call the hotline, it’s because they already believe they have the virus.
Let’s face it, the flu hotline is a shortcut.
Perhaps a necessary one, but a shortcut nonetheless. Hundreds of thousands of people are being `evaluated’ and treated, without ever having been seen by a doctor.
No one should be terribly surprised when occasional mistakes in diagnosis are made.
Of course, when problems in a program are detected, attempts should be made to rectify them. And I’m sure the NHS is going to look at the Hotline process to see if any changes are warranted.
A pandemic presents enormous challenges to society and we need to understand that not everything is going to run smoothly.
A great many things will be tried over the next year in an attempt to mitigate the effects of this crisis. Some of them will work well, some perhaps not as well. Some will need adjustment or tinkering along the way, and some may even prove ill advised and have to be abandoned.
Despite the best efforts of a lot of dedicated people, our pandemic response won’t be perfect. There will be unintended consequences, screwups, and probably some collateral damage along the way.
I hope we develop some tolerance and understanding, and don’t immediately start pointing the finger of blame every time something that is tried doesn’t work as hoped. That would be a terrible reward for the people on the front lines of this crisis.
We need to understand that not every problem has a perfect or universally fair solution, that compromises may have to be made and shortcuts taken, and that temporary reductions in standards of care may be required.
Nobody likes that, but that’s the reality of a pandemic. We might as well start getting used to the idea now.
