We are soon to enter flu season. Although we don’t know what the severity of this year’s flu season might be, the media has perpetuated the H1N1 hype to such a degree that we are left with one thought only—it will be bad. Health Canada, BC’s Public Health Office, the BC Centre for Disease Control and our health authorities have released guidelines for citizens to follow to mitigate the likelihood of contracting any flu virus.
Liberal estimates suggest that 50% of the population will come down with flu-like symptoms during this upcoming season. However, it is generally thought that front-line health care workers will be at higher risk of contracting influenza than the general public because of their greater exposure. With this in mind, here is a top 10 list for physicians to help protect themselves and their office staff as well as their patients.
You and your staff
1. Get vaccinated! It is more important than in previous years that you and your office staff receive the influenza vaccine. You won’t be doing yourself, or your patients, any favors if you show up sick to the office or are too sick to come in.
2. Ensure you have enough supplies on hand—masks, gloves, alcohol-based hand rubs, vaccines, and needles.
3. Wear a mask and gloves when examining patients who present with flu-like symptoms.
4. Keep informed. Regularly check the Public Health Office web site as well as the sites of the BC Centre for Disease Control, Canadian Medical Association, and your health authority for updated information (see the adjoining box).
5. Know the temporary fees and bill them accordingly.
6. Develop a plan to communicate effectively with patients who present with flu-like symptoms, taking into consideration the following: a receptionist checklist, triage process, explaining to patients proper etiquette for coughing and sneezing (into sleeve or upper arms), and an exam checklist for physicians, especially for your at-risk patients (pregnant, CDM, compromised).
7. Encourage non-urgent patients or those having a routine medical visit to stay home or postpone their appointments. In the short term, the frequency of follow-up visits for older patients and those with stable, chronic conditions could be decreased by providing longer prescription times or even telephone prescription refills.
8. Post signs at the entrance to waiting rooms to tell patients who think they have the flu to inform the receptionist. Surgical masks and disinfectant hand wash should be made available at the entrance to the waiting room with a sign explaining that patients who arrive with flu-like symptoms should use these supplies.
9. Wash down the exam rooms and waiting rooms as often as resources will allow. Everything should be wiped down with a damp cloth (as opposed to a dry cloth). As well, frequently touched surfaces such as stethoscopes, doorknobs, light switches, charts, and pens should be wiped down twice daily.
10. Remember the 2 metre rule—try to keep 2 metres of separation between you and your office staff and patients with flu symptoms. Perhaps segregate your waiting room, if possible, or have patients with flu symptoms escorted directly to an examination room to wait.
Each of us hopes that this flu season will not be dramatically different than in the recent past—however, as the Boy Scouts’ motto tells us, it’s to our advantage to be prepared.
—Brian Brodie, MD
Web sites with current flu information
Public Health Office of BC www.hls.gov.bc.ca/pho
Centre for Disease Control www.cdc.gov
BC Centre for Disease Control www.bccdc.ca
Canadian Medical Association www.cma.ca
Public Health Agency of Canada www.fightflu.ca
Center for Infectious Disease Research and Policy (US) www.cidrap.umn.edu
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org