Swine Flu Blues by Winslow the family doctor Had dozens of calls from patients the last 2 days wanting Tamiflu for themselves and family just in case- none of the local pharmacies have it in stock- most pharmacies sent back their supplies at the end of flu season- now what if someone really needs it- pharmacy says: Send the patient to the ER I spoke with our ER- if someone has flu symptoms they have a limited # of NP swabs to culture for rapid testing and then if + plan on sending specimen to state lab as per state and CDC recommendations . . . but will only do the highest risk febrile types - all the others get a written Rx for Tamiflu and are streeted - but wait, the pharmacies don’t have Tamiflu so the patient calls me to problem solve another unsolvable problem. If the patient is sick and tests positive likewise they are now in an extreme panic and have a written Rx for appropriate Tamiflu but nowhere to fill it- more calls to me to problem solve these unsolvable problems. I am ready willing and ready to do the testing of my patients in the office but I don’t have the NP swabs- called Quest- they are on "global backorder" - try again in a few weeks. They suggest if someone calls or shows up - Send them to the ER I ask the ER where I too can get swabs for rapid testing and possible culture- told to "go to central supply, they have lots"- Go to central supply- they have none - "these are a special order item" The ER only has a limited supply on campus - Hmmm I call Main Line Health clinical labs- they do have a limited supply. They will let me pick up 5. if I do one, I will have to immediately leave the office and drive the specimen 20 minutes to the lab and spend another 20 minutes processing the patient insurance etc. so they can do the rapid test - No tenable - so I am told to Send them to the ER I read the info from the State and CDC about the OSHA requirement that states anyone (myself or staff) obtaining specimens needs to be "Fit Tested" in a special lab periodically to ensure that we are wearing the N95 mask of the right size appropriately. I go to occupational health and they tell me there are only two sizes of the mask small and regular and if I want to be fit tested I will have to schedule a visit and be charged a handsome sum to get it done. They suggest anyone who has a cold or flu symptoms be sent to ???? The ER!!!!!!! I finally get them to agree to do special pickups of specimens here on an as needed basis and suggest they send out a memo to all primary care offices that they will supply and pick up from our offices in this current situation - we will see what happens I also asked some other local primary care practices what they are doing and the universal response seems to be . . . Send them to the ER Thank goodness our government is in control and has so wisely spent billions a year making many special interest groups very rich and others employed doing important preparations for our current situation. Looking for sanity in an unsanitary world. Winslow W. Murdoch, MD 5-1-09