SECOND OPINION:Vets have lambing; GPs have the chaotic flu-vaccine rush
THE MEDICAL world has its own internal rhythms and seasons. As the flocks of swallows depart and spider webs glisten through the autumnal mists, the standing army of Irish GPs get ready for the arrival of the refrigerated van bearing the anti-flu injections. There the syringes lie, packed like homing salmon, waiting to be injected into the biceps and triceps of the waiting patients (nobody injects the bum any more – not for the flu jab anyway).
The anti-flu serum itself is a mysterious clear fluid: part science, part gamble. An elusive group of scientists have decided, in their wisdom, which strain of influenza will be the Christmas number one, and have distilled it into a 0.5ml injection for your protection. The flu, like so many things these days, is expected to start in Asia and, helped by cheap flights and hand-shaking at Mass, to lay the Irish low. But this little jab will, we hope, be similar enough to the expected germ for the national immune system to see the blighter off.
Vets have lambing; GPs have anti-flu jabs. It lasts a few weeks, it makes a change from the routine, and you see a group of patients who rarely bother you any other time of the year. In fact, it is easy to imagine the flu-jabbers descending like snowy flocks from the hills and mountains, bleating for their vaccinations.
But it is never as simple as just giving an injection. These woolly dartboards are people, with their oddities and pathologies. And these others are GPs, who by training and nature are holistic and opportunistic.
These are the patients who have not had their blood pressure checked, their lipids done, their mood determined or gait assessed. They have had no blood tests, no X-rays. Above all, they have had no advice. They are free from health promotion, population-based investigations, opportunistic advice and age- appropriate health screening. All they want is a shot in the bum (they don’t even know about the triceps) and they will leave you alone for another year.
What does the GP do? One friend of mine in a rural area had the following announcement read out at Mass.
“The doctor would like to tell you that the flu jab will be available next Thursday evening from 5pm to 7pm in the parish hall. No other problems will be looked at. Don’t look for prescriptions, driving licence tests or forms for a gun licence. You won’t get them. All the staff will be there but don’t expect them to talk to you. Turn up, roll up your sleeve and line up. Thank you. God Bless.”
Maybe he has the right idea.They are adults after all. Perhaps they don’t want somebody to ask them about their smoking and drinking and to just hop-up-on-the-scales-there-for-a-minute-do-you-know-I-never-knew-it-went-that-high. Maybe it is a better idea to leave all that for a quieter time of the year.
For you could get seriously stressed if you don’t watch it. It’s always the ones who say they will only take a moment. They take five minutes to get the coat off, roll up the sleeve, and then mention, by the way, that they have some previously unmentioned condition – like flitting headaches accompanied by a burning feeling in the right foot on Wednesday afternoons while listening to Liveline.
And they are worried about their mother – and possibly your mother too. It will be a long chat. Now the shoes and socks are coming off and an interesting rash is discovered that’s only been there for a year. It’s standing-room only in the waiting room. The hard-won appointment system is on the brink of meltdown and the ones who only came for the shot are starting to jot down symptoms on the back of an envelope.
Of course, the ones who really need the anti-flu – those with the bad chests and the chronic conditions – don’t want it. They sit with a coy smile and say, “Ah sure I never get the flu anyway”. They obviously have a shorter memory than you do. Some feel great because they got the 0.5ml, some feel great anyway. You judge the argument to the need.
It all works out. You spin out to the nursing homes and the bedridden. You jab your staff. They jab you. As the years go by, generations of vaccines fly on their way, burying themselves in muscle, conferring immunity. The great swine flu scare showed that GPs are good at targeting populations and identifying risk groups. It all comes down to knowing the patients. Like a good shepherd.