Posts Tagged ‘flu shot’

When is influenza Work Comp?

November 7, 2017

A recurring problem, I fear,

Is the flu I get every year

Am I a jerk

To say I got it at work?

I don’t want to be a pain in the rear.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. After 3 months in northern British Columbia, and a month of occasional shifts in northwest Iowa, I have returned to the Arctic.  Any identifiable patient information has been included with permission.

Friday I worked but not very hard. I saw more people off the schedule than on due to the number of no shows.  I attended as many people with respiratory problems as with bone-and-joint problems.  As the day wore on I felt, more and more, the aching from yesterday’s 3-hour walk on the ice-covered road leading out of town.  I resolved walk more.

After work Bethany met me in the hospital cafeteria for the weekly prime rib dinner. As Iowa beef snobs we rarely leave home to eat it.  We made an exception; it turned out to be very good, and my piece of meat came large enough to overwhelm.

But my cough, gradually improving over the last 8 weeks, came back stronger than ever on the short walk back to our apartment, and I realized that my tundra-seeing expedition couldn’t account for the ache in my upper back.

I started to shiver, my nose started to run, and my cough worsened. At 9:00 PM I called the Veteran’s Administration for permission to go to the local ER.

I spent 40 of my prepaid phone’s 200 minutes on hold.

My fever and aching worsened, I took Tylenol, I broke into a sweat and I felt better. Which I told the nurse when she answered.

The nurse had no concept of Alaska’s vastness.   She asked if I could get to the VA facility in Palmer, Wasilla, or Anchorage; I told her that I was a good deal closer to the Russian border than  to any of those places.

She knew more nursing than geography.

Eventually she advised fluids, rest, and Tylenol.

Every year I get the flu shot; it’s about 50% effective at preventing flu but it’s 90% effective at preventing death from the flu. And every year, I get the flu.

I got sicker on Saturday evening and went to the ER. I anticipated and got a flu test.

During the wait for results my chills cycled with sweats twice. I took my first oseltamivir (Tamiflu) pill before I left the ER.

But as I had signed in, the slip of paper wanted to know if the problem were work-related.

So many times in the last year I asked sufferers who sought my advice if they wanted the problem put onto Work Comp (or, in Canada, onto the WCB, Workman’s Compensation Board). The vast majority refused; some feared being fired in reprisal, some didn’t want to hassle Human Resources, and some felt their regular insurance would take care of things.

I have almost no social interaction outside the hospital, and I deal with the infected on a daily basis. Until now, I understood the perspective of the self-employed: fear the Work Comp insurance rates will go up.  This time, though, I stood in the shoes of the employed.  And I understood the hesitance.

I didn’t check YES or NO. I wrote, Let’s talk.

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Fever, cough, aches, and plunging temperatures when the sun comes out

January 27, 2011

 

Epidemics of this are not new

But what is a doctor to do?

    With coughing and aches

    Till the high fever breaks,

The typical symptoms of flu.

Synopsis: I’m a family practitioner from Sioux City, Iowa.  I’m taking a sabbatical to come back from the brink of burnout.  While my one-year non-compete clause ticks off, I’m having adventures, working in out-of-the-way places, and visiting family and friends.  Currently I’m on assignment in Barrow, Alaska, the northernmost point in the US.

Three symptoms distinguish real influenza: fever, cough, and aching.  Each year the particular circulating strain will show some unique characteristics; last year, for the first time, vomiting and diarrhea accompanied most cases.  Some years headache happens to most of the patients, other years people complain of profusely runny nose.

Chaos mathematicians and complex systems analysts can explain why the flu in a community will reach a tipping point and go, well, viral.  We’re all familiar with the scenario; a few people get the flu, the first cases aren’t too bad; later cases get much worse.  At the peak of the epidemic, our co-workers stay out sick, the schools close, and we can’t get anything done.  Ninety percent of the cases occur within three weeks; the epidemic starts in the north and spreads south.

The scenario repeats itself yearly.  Except for last year, when the pandemic H1N1 “swine flu” turned out to be more of a sardine than a shark, most people got their flu shots and flu season went well.

Many years the tsunami of the flu season overwhelms the medical infrastructure; in 1993, at the end of the season, neither love nor money could have bought an influenza test kit, amantidine nor rimantidine and the chronically ill died by the score.

The virus has Barrow in its grip this week; more than half the patients I’ve seen in the last week were suffering with the same symptoms.  Today we received confirmation of influenza.

With housing in short supply in Barrow, people crowd.  Contagious diseases, especially those spread via the respiratory route, run rampant in these conditions. 

I’ve been working late every day; today I hit forty hours and went into overtime.  Yesterday I finished before supper for the first time since I got here.

I labor with some very good doctors, all hard-working team players.  We have a well-equipped hospital and a well-stocked pharmacy, and exactly six exam rooms.  Emergency medical transports, dramatic life and death cases, leave by air daily.

I wish I had more time to listen to each patient’s story.  I want to ask questions like, what did you find when you got there?  How many geese did you get and how did you get that many?  How can you load eight caribou to be pulled by one snow machine?  How do you find a wolverine?   What is the best way to use fur as a ruff on a parka?

Outside the temperature runs twenty-five degrees below zero till the sun comes up, and in the clear skies of the afternoon the mercury plunges and the radio warns people not to go out.

I can’t stop being a doctor, I don’t want to try. I just want to slow down.

September 22, 2010

I can’t stop being a doc

Leave me alone and I’ll diagnose a rock

     Say what you please

     I can see a disease,

Sometimes from the end of the block.

I can’t stop being a doctor.  I have a one-year, thirty-mile non-compete clause, so I can’t give advice or write prescriptions unless I am out-of-town.  But at the same time I make a purchase at a store or talk to someone on the street I can’t stop making diagnoses.

I can tell the sleep deprived people by the fine wrinkles on their faces, the front parts of their cheeks, and the bags under their eyes.

A particular kind of hyperthyroidism, Grave’s disease, shows itself in prominent or bulging eyes; actor Marty Feldman displays this eye finding, exophthalmos, which overlaps incompletely with a visibly enlarged thyroid, or goiter.

Parkinson’s disease displays several early findings before the tremor starts.  People walk rigidly, their smile seems frozen, they start to lean. 

People with neuropathy walk with a broad-based, uncertain gait, something like Frankenstein’s monster in the original movie. 

I looked at a clerk’s hands today and noted a rash on the left hand in the web space between the little finger and ring finger; red and swollen with sharp edges.  I wanted to tell the person that a fungus was growing there, and to use over-the-counter antifungal till it cleared.

Another person had some fine red bumps on the inside of the forearms; whether insect bites or poison ivy or other contact allergy didn’t make any difference.  I had the urge to instruct on the use of over-the-counter 1% hydrocortisone cream for itch, and to ignore it if there were no itch.

I can smell the smokers by the smell, sometimes I cough from being near them.  I want to offer advice, but I don’t if I’m in town.

I miss my work but I don’t miss the sleep deprivation.  I’m looking forward to going back to medicine on a forty-hour a week schedule. 

I’m arranging my next placements.  I’m having trouble deciding where I want to go during the month of October.  Do I want to take a job for fewer hours but better rate with very short commute, or do I want to drive further?  I know I want a better adventure, but possible work availability complicates the picture.  With many variables in many unknowns, eventually I have to commit to a course of action.

This morning at the Care Initiatives Hospice meeting we talked about patients and I made more recommendations for decreasing or eliminating drugs than I did for starting new drugs. 

At the end of the meeting, I was the first one in line for the flu shot. 

Last flu season went easily probably because we immunized so well.  The H1N1 wasn’t nearly as bad as we’d thought.  The possibility of a change in virulence remains, but looks a lot less likely.

I can’t stop being a doctor.  I don’t even want to try.  I just want to slow down.