Xofluza vs. Tamiflu

[PabsMD]

My patients don't necessarily believe in the flu shot but they definitely want treatment once the fever and myalgias start.

Has anyone had any experience prescribing/taking Xofluza? I've read that it's more expensive but slightly more efficacious than Tamiflu.

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[thegenius]

Nope...I don't even know if our formulary has it, or whether our regional pharmacies carry it.

But now that you bring it up...you are going to get a lot of people saying how crappy both are, and they are not worth prescribing (I for one am in that camp, I see more side effects than benefits empirically).

 

[TooMuchResearch]

I thought it was non-inferior to tamiflu, which doesn't work.

My patients don't necessarily believe in the flu shot but they definitely want treatment once the fever and myalgias start.

Has anyone had any experience prescribing/taking Xofluza? I've read that it's more expensive but slightly more efficacious than Tamiflu.

 

[PabsMD]

I agree that Tamiflu doesn't work well and that the side-effect profile is concerning. However, my patients don't care as their Google research tells them it's a magic bullet/instant cure. Our system is really pressing the satisfaction issue and when a patient demands a script, I counsel them regarding benefits vs. risks and document that.

 

[TooMuchResearch]

"It doesn't make you feel better faster, causes vomiting and diarrhea, doesn't prevent you from giving flu to other people, and that doesn't even cover the data the drug company covered up that makes the drug look even worse. It's also expensive. I'm happy to prescribe it if you want, though."

I don't get that many takers.

I agree that Tamiflu doesn't work well and that the side-effect profile is concerning. However, my patients don't care as their Google research tells them it's a magic bullet/instant cure. Our system is really pressing the satisfaction issue and when a patient demands a script, I counsel them regarding benefits vs. risks and document that.

 

[thegenius]

"It doesn't make you feel better faster, causes vomiting and diarrhea, doesn't prevent you from giving flu to other people, and that doesn't even cover the data the drug company covered up that makes the drug look even worse. It's also expensive. I'm happy to prescribe it if you want, though."

I don't get that many takers.

That is basically what I say. I also say that there are case reports in Japan of people getting neuropsychiatric symptoms too.

I would say I prescribe it about 20% of the time it's indicated. And that's when the patients wants it anyway after my speech.

I will though give it to people who many co-morbidities. Like COPD w/ ESRD. I had a patient last year who have influenza, ESRD. Her SBP was 115 in the ER (she averages 140-170). I admitted her because she was weak, and had a cardiac arrest while on the toilet the next day.

 

[gamerEMdoc]

I basically just do what the CDC says. Give it in the highest risk population, offer it in other populations with a risk (side effects) vs benefit (surprise there probably isnt any) discussion.

 

[deleted109597]

That is basically what I say. I also say that there are case reports in Japan of people getting neuropsychiatric symptoms too.

I would say I prescribe it about 20% of the time it's indicated. And that's when the patients wants it anyway after my speech.

I will though give it to people who many co-morbidities. Like COPD w/ ESRD. I had a patient last year who have influenza, ESRD. Her SBP was 115 in the ER (she averages 140-170). I admitted her because she was weak, and had a cardiac arrest while on the toilet the next day.

There are way more than case reports. Lots of people hallucinate on it.
The Japanese data shows suicides, which is way worse.

It doesn't bother me to give it if the patient wants it. They're going to find a UC that will give it, and at the end of the day if it doesn't help any, it doesn't matter if the virus develops resistance.

 

[pkwraith]

Last time I checked out of curiosity, our regional pharmacies do carry xoflueza, they've just been sold out.

I can see the utility of xofluza as an alternative if it is available, because it is a one time pill.
I would probably ask "Would you rather be violently vomiting (tamiflu) or have explosive diarrhea (xofluza)"

 

[Jabbed]

The (industry-funded) trial showed decreased viral shedding at 24 hours, slightly higher incidence of GI effects. One time dosing is always neat.

I gave it to a 20-something whose wife was going into labor. It was one of the few times that I felt it might do some good.

 

[erdoc00]

Just curious but how many of you have actually taken Tamiflu?

I had several patients who were rapid flu positive who I put on Tamiflu within the 48 hour window. When i followed up with them, they all reported they began to feel better the next day and none had any significant side effects.

After this when I started getting myalgias myself, i figured I would give it a try. I took it and was feeling better the next day and did not experience any significant gi or psychiatric side effects.

Obviously this is not a scientific study but I'm curious if people who think it doesn't work or think it has concerning side effects have clinical experience to corroborate those views.

 

[gamerEMdoc]

Just curious but how many of you have actually taken Tamiflu?

I had several patients who were rapid flu positive who I put on Tamiflu within the 48 hour window. When i followed up with them, they all reported they began to feel better the next day and none had any significant side effects.

After this when I started getting myalgias myself, i figured I would give it a try. I took it and was feeling better the next day and did not experience any significant gi or psychiatric side effects.

Obviously this is not a scientific study but I'm curious if people who think it doesn't work or think it has concerning side effects have clinical experience to corroborate those views.

Well, in actual clinical trials of the drug, it reduced symptoms from a 7 day average to a 6.5 day average vs placebo in patients taking the drug within 48 hrs of the onset of symptoms. So I'm pretty sure people reporting feeling miraculously better the next day either got lucky with their symptoms or got a placebo effect, because no scientific data suggests tamiflu makes you better that quickly.

As a contrary, I have seen many patients get started on tamiflu and return to the ED in 24-48 hours feeling worse. Using the same logic, I could say that's evidence that tamiflu makes the flu worse. It doesn't. It's just that if you look at individual stories, it's easy to pick out some that just had shorter or longer courses of illness, and it has nothing to do with the medication itself.

The reality is, tamiflu probably does do what studies show it does. Make a tiny reduction in the length of symtoms with a small risk of other side effects. Hardly worth the price tag.

The one good thing about the lengthy discussion I have to have about tamiflu with every patient that comes in for flu is, it gives me a soapbox to really discuss what works for the flu. The importance of yearly vaccination, staying home and and good hand hygiene when you and family members are ill.

 

[emergentmd]

So hard for Er docs to know if it works.

Problem is if you don't, and they do an internet search or a friend asked why they didn't get prescribed then you essentially have an unhappy customer.

I do know a of family with two kids that had it with similar timing/symptoms. one got tami, one xof. The xof kid was better the next day. N=1 doesn't have any scientific facts but the parent thought xof did wonders.

 

[thegenius]

Just curious but how many of you have actually taken Tamiflu?

I had several patients who were rapid flu positive who I put on Tamiflu within the 48 hour window. When i followed up with them, they all reported they began to feel better the next day and none had any significant side effects.

After this when I started getting myalgias myself, i figured I would give it a try. I took it and was feeling better the next day and did not experience any significant gi or psychiatric side effects.

Obviously this is not a scientific study but I'm curious if people who think it doesn't work or think it has concerning side effects have clinical experience to corroborate those views.

A colleague of mine said it worked great when she had it.

 

[deleted109597]

So hard for Er docs to know if it works.

Problem is if you don't, and they do an internet search or a friend asked why they didn't get prescribed then you essentially have an unhappy customer.

I do know a of family with two kids that had it with similar timing/symptoms. one got tami, one xof. The xof kid was better the next day. N=1 doesn't have any scientific facts but the parent thought xof did wonders.

It's not hard to know if it works. The trials funded by the pharmaceutical companies showed it didn't.
If people want it, sure. Just warn them (and write it in the note as such)

 

[TheSingularity]

A colleague of mine said it worked great when she had it.

Placebo anyone?

Tbh I prescribe it when in the window. Why? Cause the CDC recommends it and if you have a bad outcome and you didn't follow a CDC recommendation you might as well write the check.

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[TooMuchResearch]

They recommended it strongly a few years ago. I'm not sure that's the case anymore.

Placebo anyone?

Tbh I prescribe it when in the window. Why? Cause the CDC recommends it and if you have a bad outcome and you didn't follow a CDC recommendation you might as well write the check.

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[gamerEMdoc]

They recommended it strongly a few years ago. I'm not sure that's the case anymore.

It still is.

 

[migm]

Most of the studies use IFI rather than lab confirmed flu afaik.. that probably weakens the results reported overall. I'd use it. Like 1 in 9 get diarrhea with amoxil/pcn

 

[wholeheartedly]

Interesting tangent on this topic

Should Oseltamivir Become an Over-the-Counter Drug?

News broke last week that oseltamivir — most commonly known by its clever (expired) brand name, Tamiflu — may be heading to pharmacies soon as an over-the-counter (OTC) drug, available without a prescription. After hearing this, I immediately thought of several reasons both supporting and...

blogs.jwatch.org

 

[deleted836128]

Just curious but how many of you have actually taken Tamiflu?

I had several patients who were rapid flu positive who I put on Tamiflu within the 48 hour window. When i followed up with them, they all reported they began to feel better the next day and none had any significant side effects.

After this when I started getting myalgias myself, i figured I would give it a try. I took it and was feeling better the next day and did not experience any significant gi or psychiatric side effects.

Obviously this is not a scientific study but I'm curious if people who think it doesn't work or think it has concerning side effects have clinical experience to corroborate those views.

I wish I knew some more anecdotes for the stuff - would be interesting to hear about. Personally - I had the flu in 2015 and took Tamiflu within probably twelve hours of symptom onset and I don't think it did jack. I was stuck in bed for a week - have never been that sick - and was incredibly fatigued the second week. It took two and a half weeks to feel normal.

 

[Zebra Hunter]

It still is.

It actually isn't.

The exact wording from the CDC is, "Antiviral treatment also can be CONSIDERED for any previously healthy, symptomatic outpatient not at high risk for influenza complications, who is diagnosed with confirmed or suspected influenza, on the basis of clinical judgment, if treatment can be initiated within 48 hours of illness onset."

Considered is not the same as a recommendation.

 

[gamerEMdoc]

It actually isn't.

The exact wording from the CDC is, "Antiviral treatment also can be CONSIDERED for any previously healthy, symptomatic outpatient not at high risk for influenza complications, who is diagnosed with confirmed or suspected influenza, on the basis of clinical judgment, if treatment can be initiated within 48 hours of illness onset."

Considered is not the same as a recommendation.

Yeah its recommended to be given for high risk people. And its recommended you consider it for everyone. I dont think any of that’s changed as far back as I can remember. I could be wrong, but I dont remember the cdc ever recommending anything but considering tamiflu in healthy people.

 

[e30ftw]

The CDC has a long list of recommendations for influenza treatment which include "severe progressive illness" and many other complicating features.

Every year I'm aware of 10-15 healthy-ish 18-50 year olds in the community who don't meet the typical higher risk criteria who die or go on ECMO or something from the flu.

If you see any of those patients early on and they have an indication for tamiflu (which a med-mal attorney will stretch the indication and will find "expert" witnesses" to support..) you're totally ****ed.

I give it for what the CDC recommends while understanding that it probably doesn't work. If an otherwise healthy pt presents with <24 hrs of symptoms I explain the side effects and benefits and if the patient wants it I rx it and to be honest, feel better about the chart.. sad as that is.

I'm not aware of any benefit of xofluza other than the 1 time dosing and have not prescribed it due to increased cost and unfamiliarity.

 

[Brigade4Radiant]

The CDC has a long list of recommendations for influenza treatment which include "severe progressive illness" and many other complicating features.

Every year I'm aware of 10-15 healthy-ish 18-50 year olds in the community who don't meet the typical higher risk criteria who die or go on ECMO or something from the flu.

If you see any of those patients early on and they have an indication for tamiflu (which a med-mal attorney will stretch the indication and will find "expert" witnesses" to support..) you're totally ****ed.

I give it for what the CDC recommends while understanding that it probably doesn't work. If an otherwise healthy pt presents with <24 hrs of symptoms I explain the side effects and benefits and if the patient wants it I rx it and to be honest, feel better about the chart.. sad as that is.

I'm not aware of any benefit of xofluza other than the 1 time dosing and have not prescribed it due to increased cost and unfamiliarity.

ESPN reporter Edward Aschoff dies at age 34 from pneumonia

(CNN) – Edward Aschoff, a college football reporter for ESPN, died Tuesday on his 34th birthday, according to ESPN. “We are very sorry to have to share the devastating news of the tragi…

kfor.com

"Your honor my client had flu like symptoms and wasn't given Tamiflu which the scientific community clearly states shows benefit from flu complications like Pneumonia."

*Cue reporter montage and impact

Honestly it depends on the state where you practice I would never live in a bad med mal state.

 

[Perrotfish]

Interesting tangent on this topic

Should Oseltamivir Become an Over-the-Counter Drug?

News broke last week that oseltamivir — most commonly known by its clever (expired) brand name, Tamiflu — may be heading to pharmacies soon as an over-the-counter (OTC) drug, available without a prescription. After hearing this, I immediately thought of several reasons both supporting and...

blogs.jwatch.org

I hope it goes OTC. By far the best supported use for Tamiflu is as prophylaxis against flu when you have a close contact with the flu. Studies show that, if you have any household contact with flu there is a very good chance you are getting flu as well. I would guess that if that contact is your own toddler the rate of flu transmission is close to 100%. If you take prophylactic Tamiflu the transmission rate drops dramatically. But nobody actually takes prophylactic Tamiflu as an outpatient because our healthcare system is just not set up to get prescriptions to someone who is currently healthy. If it was OTC I would be sending the parents of every flu positive child out to buy prophylaxis for themselves.

 

[emergentmd]

One of my partner saw a healthy young pt with positive flu, outside the window. Didn't get tamiflu after a long discussion.
Pt went to PCP next day bc wasn't better, got tamiflu, felt better after.
Complained, left bad reviews, etc.

Not worth the battle. Crucify me if you want for giving amoxil to my viral URIs.

Its like Mcdonalds. They come wanting antibiotics their way. Don't give it is like telling an obese person that they can't get their supersized big mac meal.

 

[gamerEMdoc]

One of my partner saw a healthy young pt with positive flu, outside the window. Didn't get tamiflu after a long discussion.
Pt went to PCP next day bc wasn't better, got tamiflu, felt better after.
Complained, left bad reviews, etc.

Not worth the battle. Crucify me if you want for giving amoxil to my viral URIs.

Its like Mcdonalds. They come wanting antibiotics their way. Don't give it is like telling an obese person that they can't get their supersized big mac meal.

Honestly, what is the matter if someone complains if it is unfounded? If someone complains you didm’t give a healthy person tamiflu after more than 48 hours, what happens? That would get laughed out of our peer review process if it even made it to peer review, more likely it would just be ignored and patient satisfaction would send some BS response to the patient and we’d never know about it.

There are real legal threats in medicine, but someone complaining about the standard of care isn;’t one of them.

Now I can see being upset about it if your hospital never backs you up and caves to all complaints and holds you accountable. But if you work for a director/hospital who is holding you accountable for practicing the standard of care as defined by the CDC... you are working for the wrong people.

 

[BoardingDoc]

One of my partner saw a healthy young pt with positive flu, outside the window. Didn't get tamiflu after a long discussion.
Pt went to PCP next day bc wasn't better, got tamiflu, felt better after.
Complained, left bad reviews, etc.

Not worth the battle. Crucify me if you want for giving amoxil to my viral URIs.

Its like Mcdonalds. They come wanting antibiotics their way. Don't give it is like telling an obese person that they can't get their supersized big mac meal.

Agree with the above from @gamerEMdoc, if your hospital is constantly coming down on you and threatening your job for providing appropriate care and pandering to complaints that have no merit, I can see where you'd take that approach. I would also suggest looking for a new job. If that isn't possible due to geographic/family/whatever constraints then I can see how this could become an occasional acquiescence.

Otherwise though, I agree that there is no justification for prescribing unneeded medications to someone just because they want them and threaten to leave a bad review or make a complaint. As I've said before, if you're at the point where you're consciously practicing bad medicine because you're "not willing to fight," I suggest you reevaluate your decision to continue treating patients.

 

[emergentmd]

I get it. I get it. Call me an antibiotic sell out. Sometimes for my mental health its easier to just give patients what they want when its not in left field.

We All do it. If we didn't then we wouldn't order 90% of CT/Xrays.

If it saves me 5 unhappy patients, 30 extra minutes of convincing, better patient sats then so be it. Take your amoxil script that you came in for.

You have ankle pain for 2 wks, you want an xray? do it, get them out.
You want a CXR for a cough x 1 wk with normal vitals/exams? Sure why not.

You may want to argue, but we work in a patient care and customer service industry.

We all do. Surgeons, plastics, anesthesiology. All of us do that

 

[gamerEMdoc]

, 30 extra minutes of convincing,

Now that's the main reason we do things that are probably unnecessary. Its easier to order something than try to convince someone to leave without what they came for. Med mal is a driving force behind some things as well, but most of the time, when we order something just to order it, its just the path of least resistance when busy.

 

[thegenius]

I think that @gamerEMdoc, @BoardingDoc, and @emergentmd are all correct

 

[thegenius]

I hope it goes OTC. By far the best supported use for Tamiflu is as prophylaxis against flu when you have a close contact with the flu. Studies show that, if you have any household contact with flu there is a very good chance you are getting flu as well. I would guess that if that contact is your own toddler the rate of flu transmission is close to 100%. If you take prophylactic Tamiflu the transmission rate drops dramatically. But nobody actually takes prophylactic Tamiflu as an outpatient because our healthcare system is just not set up to get prescriptions to someone who is currently healthy. If it was OTC I would be sending the parents of every flu positive child out to buy prophylaxis for themselves.

Gosh I hope it doesn't. I'm not particularly excited about now prescribing an OTC medicine that is lousy. I think Tylenol and motrin are superior medicines than oseltamivir for Flu and people come in now just to get that Rx. it's easy medicine but it gets real old quickly

 

[GeneralVeers]

Gosh I hope it doesn't. I'm not particularly excited about now prescribing an OTC medicine that is lousy. I think Tylenol and motrin are superior medicines than oseltamivir for Flu and people come in now just to get that Rx. it's easy medicine but it gets real old quickly

It helps to just think of your job as a factory job, and the patients as widgets. Churn out the widgets as fast as you can. It's not your job to question the design or destination of the widgets. Just make them, clock out, go home and have a bourbon.

 

[Perrotfish]

Gosh I hope it doesn't. I'm not particularly excited about now prescribing an OTC medicine that is lousy. I think Tylenol and motrin are superior medicines than oseltamivir for Flu and people come in now just to get that Rx. it's easy medicine but it gets real old quickly

Its not a lousy medicine for prophylaxis. If you have a contact with flu and you start Tamiflu before you have symptoms it reduces your odds of getting flu by 80%, and if you get flu anyway it reduces the average duration of your symptoms by 50%.

Tamiflu is an amazing medicine for preventing the flu and doesn't do very much for you if you already have symptoms. So naturally we prescribe Tamiflu to everyone who has the flu and we don't give it to any of their household contacts.

 

[TooMuchResearch]

Do you have any quick citations for this? I'd be interested to find an actual use for tamiflu

Its not a lousy medicine for prophylaxis. If you have a contact with flu and you start Tamiflu before you have symptoms it reduces your odds of getting flu by 80%, and if you get flu anyway it reduces the average duration of your symptoms by 50%.

Tamiflu is an amazing medicine for preventing the flu and doesn't do very much for you if you already have symptoms. So naturally we prescribe Tamiflu to everyone who has the flu and we don't give it to any of their household contacts.

 

[Perrotfish]

Do you have any quick citations for this? I'd be interested to find an actual use for tamiflu

Citation here

 

[thegenius]

Citation here

Not a stunning benefit by any stretch of the imagination. Cochrane Review
It does suggest a modest benefit prophylactically with number needed to benefit being anywhere from 7 to 50 for prophylaxis depending on whether it's an individual vs. a family setting. That has to be weighed against the harms (number needed to harm) ranging from 25-75.

It's just not a good medicine. That's all there is too it. These are small benefits we are talking about.

The problem with making it OTC is people think every sniffle is the flu, they will be less likely to get vaccines for it, and they might be masking more dangerous conditions that they won't see a doctor for.

I do not think it's "an amazing" medicine as quoted above.

How does oseltamivir compare to the flu vaccine for prevention of symptomatic influenza?

 

[emergentmd]

It helps to just think of your job as a factory job, and the patients as widgets. Churn out the widgets as fast as you can. It's not your job to question the design or destination of the widgets. Just make them, clock out, go home and have a bourbon.

Not much different than a normal sized Breasted women going to the plastic surgeon to get supersized. if she wants, can pay, he does it. Doubt he stays up worrying about her future issues like infections, back pain, etc.

 

[deleted109597]

Tamiflu is an amazing medicine for preventing the flu and doesn't do very much for you if you already have symptoms. So naturally we prescribe Tamiflu to everyone who has the flu and we don't give it to any of their household contacts.

Well it's not like their household contacts are signing in as patients.
Your malpractice insurance does not cover you for any harms committed for people who aren't patients at your primary workplace. Good Samaritan isn't covering that either.
Also, it's not as good as you're portraying. And since whatever minimal benefit there is will be unlikely to be changed much by any resistance, it won't be a great loss for me.
But no, I'm not prescribing it for family unless they're patients. Similarly, I'm not prescribing "refills" or "other doses" for the patient and telling the family to give it to others. That's insurance fraud.

 

[Perrotfish]

Not a stunning benefit by any stretch of the imagination. Cochrane Review
It does suggest a modest benefit prophylactically with number needed to benefit being anywhere from 7 to 50 for prophylaxis depending on whether it's an individual vs. a family setting. That has to be weighed against the harms (number needed to harm) ranging from 25-75.

It's just not a good medicine. That's all there is too it. These are small benefits we are talking about.

The problem with making it OTC is people think every sniffle is the flu, they will be less likely to get vaccines for it, and they might be masking more dangerous conditions that they won't see a doctor for.

I do not think it's "an amazing" medicine as quoted above.

How does oseltamivir compare to the flu vaccine for prevention of symptomatic influenza?

If I'm reading correctly the Cochrae review is reviewing studies of seasonal prophylaxis. Thus the high NNT (because only 10% of people are getting flu in the first place) and the low NNH (because you are exposing people to multiple months of daily antivirals).

The metastudy in my citation was of brief prophylaxis in patients with a known household contact. Much lower NNT and much higher NNH. If someone in your household has PCR confirmed flu you have a 40% chance of getting it too (see my first post). Prophylaxis decreases your chance of getting flu by 80%. That's for complete prevention of symptomatic flu.

Well it's not like their household contacts are signing in as patients.
Your malpractice insurance does not cover you for any harms committed for people who aren't patients at your primary workplace. Good Samaritan isn't covering that either.

Im aware. That's why I said I hope it becomes OTC.

 

[thegenius]

If I'm reading correctly the Cochrae review is reviewing studies of seasonal prophylaxis. Thus the high NNT (because only 10% of people are getting flu in the first place) and the low NNH (because you are exposing people to multiple months of daily antivirals).

The metastudy in my citation was of brief prophylaxis in patients with a known household contact. Much lower NNT and much higher NNH. If someone in your household has PCR confirmed flu you have a 40% chance of getting it too (see my first post). Prophylaxis decreases your chance of getting flu by 80%. That's for complete prevention of symptomatic flu.



Im aware. That's why I said I hope it becomes OTC.

It appears that you are relying upon people to accurately diagnose themselves with flu, because what is going to happen is someone will get the sniffles, think they have the flu, just start taking OTC oseltamivir, and then start telling other family members they have the flu, and everybody else starts taking oseltamivir at some point during the time they get the sniffles (0 to 5-7 days let’s say) and everybody starts taking a drug of modest benefit for a disease they don’t have with distinct side effects.

I would rather invest the money required for this for increasing flu vaccine compliance. This sounds like a public health question.

 

[Perrotfish]

I would rather invest the money required for this for increasing flu vaccine compliance. This sounds like a public health question.

1) These are not mutually exclusive interventions

2) Are you working to increase flu vaccine compliance? Does your ER offer the flu vaccine?

 

[thegenius]

1) These are not mutually exclusive interventions

2) Are you working to increase flu vaccine compliance? Does your ER offer the flu vaccine?

That is true we could do both.

I am an ER physician, not a PCP nor public health official. I deal with medical emergencies. Prophylaxis of influenza (either by vaccine or medicine) is not a life threatening emergency.

I’m really curious about this steadfast position you have about “amazing” tamiflu (the word you used and you wrote above.)

Anyway I think we have a difference of opinion and that is OK!! I probably won’t respond anymore to this particular issue unless something changes. As I believe we are not going to change each other’s opinions.

 

[RustedFox]

1) These are not mutually exclusive interventions

2) Are you working to increase flu vaccine compliance? Does your ER offer the flu vaccine?

Yep. Let people just come to the ER for their flu vaccine, when they can and should get them at their doc's office, pharmacy, or even grocery store (and get a $10 coupon for it!)

Nothing about "I need a flu shot" is emergent.

Still, I like a lot of your contributions, homey. But come on; we gotta draw a line here.

 

[deuist]

I like the idea of offering all non-critical patients flu vaccines in the ED. The request could be automatic from the nurse just like "Do you feel safe at home?" The order could also reflexive so that the doctor does not have to get involved. The universal vaccination against influenza from the ED makes a whole lot better sense than when New York made every physician offer HIV testing.

 

[RustedFox]

I like the idea of offering all non-critical patients flu vaccines in the ED. The request could be automatic from the nurse just like "Do you feel safe at home?" The order could also reflexive so that the doctor does not have to get involved. The universal vaccination against influenza from the ED makes a whole lot better sense than when New York made every physician offer HIV testing.

NO. No. No. No. No. No.

 

[VA Hopeful Dr]

Better idea: if you don't get the flu shot every year after the first time you get the flu you can't be prescribed Tamiflu.

 

[TheSingularity]

Why just after the first time. Why not from time zero?

Better idea: if you don't get the flu shot every year after the first time you get the flu you can't be prescribed Tamiflu.

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[VA Hopeful Dr]

Why just after the first time. Why not from time zero?

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Because it's one thing to ignore what us uppity doctors tell you to do.

It's another to have a week of high fevers and awful body aches and then do absolutely nothing different next year to try and prevent that.