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With all the media coverage of Ebola and enterovirus D68, there are several things your practice can do to ease patient and staff concern. Here's where to begin.
"Keep calm and carry on."
This phrase, made popular in England during WWII, is extremely cogent now with all the media coverage of Ebola and enterovirus D68 infections. Now, more than ever, we must use our expertise as physicians in dealing with patients' fears as well as ensuring that our staff feels competent and comfortable in their positions.
In pediatrics, we deal with prevention and treatment of infectious diseases on a daily basis. During well visits, we ensure that our patients receive their vaccinations and we treat many varieties of illnesses that are infectious, including strep throat, influenza, impetigo, and ear infections caused by cold viruses. Children are incredibly efficient at spreading germs because they do not cover their mouth when they cough and sneeze and are not very good at washing their hands frequently. Toddlers especially have been observed to touch their face up to 80 or more times per hour (and this time of year, "snotty nosed kids" are everywhere).
So what should your office be doing?
1. Stay abreast of the frequent updates from the CDC. They are disseminating information as quickly as it is learned. Remember that many of your patients may not trust the CDC or other governmental agencies (and if you listen to talk radio, the conspiracy theorists are having a hay day with the current situation). Talk with your staff so that they understand these illnesses as well as you do and keep your practice website up to date with the latest information.
2. If you are a primary-care practice, all patients that call with complaints of a fever should be asked about recent travel in Africa as well as houseguests/family members that may have had travel to and from the Ebola regions. On our schedules, patient complaints are listed as "fever/no travel" and documented in their charts. Next week, we will be asking our morning walk-in patients about fever and travel history as they come in the door.
3. Make an emergency plan for your office. You should have one of these already, but now is a good time to review your strategy should you need to isolate a contagious patient. We routinely have masks and gloves in our office, but will be getting face shields, gowns, and shoe covers. We have decided that we will not be getting the full body hazmat suits, at least not at this point in time. We also will be conducting drills in proper use of personal protection equipment and especially in the safe removal of personal protective equipment.
4. Know your local hospital and health department policies about how to send a possible Ebola patient to the emergency department. At our local hospital, we simply need to notify them that we would be sending such a patient to them so they can take proper measures.
5. Get your flu vaccine! Get your flu vaccine! Get your flu vaccine! (Did I mention to get your flu vaccine?) Make sure you staff gets theirs as well! Let’s be real … thousands of people die from flu every year. About 130 children died of flu last year. While the enterovirus is frightening and terrible, there have currently been six deaths from this virus. Influenza will be far more deadly than that! (PS: get your flu vaccine!).
6. Most of all, do what health professionals are best at doing: explaining complex medical concepts to those less educated or able to understand these ideas. Physicians and nurses routinely have to break down complicated information to our patients. Also continue to educate your non-medical staff about the biology and approach to Ebola and enterovirus D68. When people know what to do in a situation, they are empowered and feel less helpless and afraid.
And even if you are nervous, keep calm and carry on. Your assured presence will help everyone in your office to maintain their cool and help the practice do what is right for your patients.