We should all take influenza and COVID-19 seriously; consider my suggestions, talk to your personal doctor, keep up with recommendations from your local public health professionals, and do your part to keep your family and community well.
Influenza and Coronavirus
When I first published this post, I didn’t know these basic recommendations help fight another serious infectious respiratory disease-COVID-19 due to the SARS-CoV-2.
1. If you think you have the “flu”, remember it could be something else.
To many people “the flu” is any respiratory illness characterized by fever, cough, congestion, fatigue, and aches. That term has become so nonspecific even we doctors use it that way. But flu should refer to influenza, one of many viruses that cause respiratory illness. The other major ones are the COVID-19 virus and RSV (respiratory syncytial virus).
Several other viruses cause mild respiratory illnesses such as
Pneumonia is a respiratory illness caused by several viruses and bacteria and less commonly fungi. I’m not discussing those in this post.
The respiratory tract including the nose, sinuses, mouth, throat, trachea, bronchi in blue and the lungs (pink). Infections can involve the breathing organs from the nose all the way down to the lungs. (photo complimentary from Pixabay)
2. If your doctor thinks you have influenza or COVID, take it seriously .
Before the “rapid flu” test, we doctors diagnosed influenza by the characteristic symptoms, exam, and knowing there was an outbreak in the community. The test is helpful for confirmation but like the COVID test may be negative depending on when the test occurs.
3. The best way to prevent influenza is by vaccination.
The World Health Organization (WHO), Centers for Disease Control and Prevention(CDC) , the National Foundation for Infectious Disease and other reputable medical organizations recommend vaccination against influenza.
People refuse vaccination because they believe it is ineffective, unnecessary, dangerous, toxic, unnatural, subversive, and who knows what else. I don’t think I or anyone else are going to change their minds.
My family and I always get vaccinations which have successfully protected us without side effects or adverse reactions. There are risks, just like there are with any medical procedure, or lots of other things we do in life. In this case, we have decided the benefit outweighs the risk.
If you don’t want a “flu shot”, discuss it with your doctor before saying no. Your doctor can explain any concerning information you have heard and offer reassurance Please listen.
4. Stay away from others if you are sick.
It’s not a coincidence that influenza outbreaks coincide with the American holiday season (approximately November through January). So to protect us all,
Stay home if you are sick, and ask your family, co-workers, and employees to do the same.
Cover your nose and mouth when coughing or sneezing; use your sleeve, not your hand.
Keep your hands away from your eyes, nose, and mouth.
Wash your hands frequently, thoroughly, and long enough.
Wash frequently touched surfaces with disinfectant.
a common sight now in public restrooms
5. If you get sick, don’t ask your doctor for an antibiotic.
Antibiotics attack bacteria. Influenza and 99% of all respiratory illnesses are due to viruses.
There are influenza antiviral drugs that will “shorten the duration and severity of symptoms” by 1-2 days if started early. The effectiveness is uncertain for an illness that will resolve within 10-14 days regardless. But if it gets you back to school or work a day earlier, it may be worth the cost-they are not cheap drugs.
For COVID, the antivirals minimize the chance of the illness becoming severe, especially for high-risk people.
Otherwise, the treatment is“symptomatic” or “supportive” care for the milder respiratory infections.
Rest; eat and drink as normally as possible; extra fluids if running a fever
Breathing moist air using a humidifier helps with cough and congestion.
(The previous are affiliate links. )
6. Influenza and COVID complications
People die from complications of influenza, and infants, young children and the elderly have the most significant risk. The most common fatal complication is bacterial pneumonia, an infection in the lung. Influenza can also attack the nervous system causing brain inflammation (encephalitis and/or meningitis) and paralysis in the form of Guillain-Barre syndrome.
Healthy lungs with no signs of pneumonia.
Persons with chronic illnesses like diabetes, lung disorders, depressed immune systems, and cancer are at greater risk of complications and should always consult a physician if feeling ill. If you don’t know if you fall into that category, ask your doctor.
what you really need to know
We should all take influenza and COVID-19 seriously; consider my suggestions, talk to your personal doctor, keep up with recommendations from your local public health professionals, and do your part to keep your family and community well.
“Most common infections, such as colds, flu, most sore throats, bronchitis, and many sinus and ear infections, are caused by viruses and do not respond to antibiotic treatment. “
“You may think of antibiotics as safe, harmless drugs with no potential for serious effects. Usually, antibiotics are well tolerated and safe. But serious side effects are possible, though infrequent.”
“If you have a bacterial sinus infection with more than mild symptoms, an antibiotic may relieve symptoms and help you recover sooner. “
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A couple of months into medical school, Dr. Weinkle interviewed a distressed patient in acute alcohol withdrawal. He tried to develop empathy for the man as he unraveled his long history of alcohol abuse and explored his reasons for trying to quit. However,as he proceeded to examine the patient, his empathy evaporated when the man rolled up his sleeve for a blood pressure check- revealing a huge tattoo of a Nazi swastika.
Creating Authentic Relationships in Modern Healthcare.
This post has been updated October 2020.
In HEALING PEOPLE,NOT PATIENTS Dr. Weinkle describes ways he believes the current healthcare system in our country fails to meet the needs of both patients and physicians. Reading it, I thought of a television medical drama in which a determined, idealistic young doctor fights a bureaucratic system to care for disenfranchised patients. Critics call the show unrealistic, but if they read Dr. Weinkle’s book, they may decide it’s not so far fetched.
The author, Jonathan Weinkle, M.D. , FAAP
Dr. Weinkle practices primary care medicine at Squirrel Hill Health Center, a federally qualified health clinic in Pittsburgh Pennsylvania. He serves as Clinical Assistant Professor of Pediatrics and Family Medicine at the University of Pittsburgh, where he also attended medical school. He lives with his wife and three sons.
Dr. Weinkle contacted me after reading my review of a book by Dr. Danielle Ofri. He asked if I would consider reading and reviewing his book also. I agreed, and he provided a complimentary PDF copy.
That was 2 years ago. Little did we know or imagine how different medicine, and everything else in our world would be by late 2020. In a blog post, Dr. Weinkle reflected on how the SARS-CoV-2 pandemic has changed his approach to his medical practice and to his faith.
Two years ago that doctor (himself) had just published a new book about listening to people, finding the person within the patient, and overcoming systems and stigmata to provide them with kind, respectful, compassionate and excellent care. That doctor had no idea that over the next two years, the world would fall apart again, and again, and again. That doctor has changed, because he is exhausted.
Unfortunately, that’s how most of the world is feeling these days, and how a lot of the people I care for feel much of the time. Shocked and confused. “Why me?” God created a universe, and it is going to pieces around me. God gave me a body and it’s going to pieces on me.
Dr. Weinkle
Why our healthcare system is broken
In the book, he identifies the EHR -electronic health record, as part of the problem, because it doesn’t allow him to express himself the way he would like. He prefers to
open a patient’s (paper) chart,(so it) tells me a story about the patient much like he might tell himself, almost as if I am reading a medical memoir
Although he calls this book a “how to”- how to restore the sacredness of the doctor-patient relationship– it also reads like the “medical memoir” he prefers for a patient. It’s his memoir, a telling of his journey from a medical student entering the “adventure” of medicine to a graduate physician who believes
“Practicing medicine is a privilege, a gift- a sacred trust.
He illustrates several issues plaguing modern medicine using anecdotes about patients from his practice (with details changed to preserve privacy and confidentiality). Our current medical system sabotages healing by
Fractured communication
Muddled priorities, where paper work takes precedence over patients
Procedures valued over counselling
Volume incentivized over value
Turning humans in pain into consumers, “as if they were buying televisions”
A turning point and lesson learned
A couple of months into medical school, Dr. Weinkle interviewed a distressed patient in acute alcohol withdrawal. He tried to develop empathy for the man as he unraveled his long history of alcohol abuse and explored his reasons for trying to quit.
However,as he proceeded to examine the patient, his empathy evaporated when the man rolled up his sleeve for a blood pressure check- revealing a huge tattoo of a Nazi swastika.
Dr. Weinkle is Jewish.
“I am not a vindictive person, but all I could think was, “Well, it serves him right. This is poetic justice.”
He excused himself, never telling his preceptor how ill it (the tattoo) made him feel, or the malicious thoughts it triggered in his mind.
In HEALING PEOPLE, NOT PATIENTS, Dr. Weinkle explains how he learned to change those kinds of encounters into ones with
Open, honest communication, mutual respect, and shared purpose, even when systemic problems push them into adversarial positions.
But it’s not easy.
even when everyone has the best of intentions, building a covenantal relationship in the current healthcare system is about as easy as building a house on the Carolina coast and not having it destroyed by a hurricane.
A FQHC is the closest thing we in the U.S. have to “socialized medicine.” Dr. Weinkle has worked in one for 10 years. As he describes it, in a FQHC
Anyone who is a stranger to the healthcare system, who has to clear high barriers in order to access care, should be welcomed in and have help knocking down those barriers.
Most doctors concentrate on helping patients manage acute and chronic disease and try to address the major causes of disease and death -smoking, poor eating, lack of exercise, stress, sleep deprivation, substance use, and obesity. But doctors like Dr. Weinkle tackle other challenges , the “social determinants” of health. These include
Inadequate houses or homelessness
Lack of reliable transportatin
Unsafe neighborhoods
Food Deserts, where healthy food is unavailable
Language, ethnic, or cultural differences
Discrimination and/or exclusion
Unemployment, low wages, and/or poverty
Limited education and/or education opportunity
His patient panel consists of people who are
Refugees, who often speak little or no English
Members of ethnic minorities, including African Americans and Hispanics
LGBTQ persons
People who are mentally ill and/or developmentally challenged
People with stigmatizing illnesses, such as HIV/AIDS
People with substance abuse
People who have been incarcerated
Dr. Weinkle feels at home taking care of them because
“I come from a long line of people who have been strangers in a long line of places. We are supposed to understand how it feels to be shut out, demonized, misunderstood, or simply ignored.”
Since I finished residency many years ago, I have had limited experience treating these types of patients, but enough that I understand the challenge, frustration, and sometimes satisfaction of doing so. Non medical professionals may be surprised by Dr. Weinkle’s descriptions of dealing with patients who are often unable or unwilling to cooperate with even basic healthcare steps.
American medical care has transformed in the past 50 years but most of us wish it still worked like in the “good old days. As Dr. Weinkle describes it
most doctors were solo practitioners who did everything, and a patient, especially in a smaller town, could expect care that felt like home. Continuity throughout their life… and accompanying them through old age. Presence wherever and whenever it was needed, in the middle of the night,
Unfortunately, medicine in the 21st century doesn’t look like that because
There are too many different kinds of care,… and too many demands on a doctor’s time to enable this kind of practice ..
Hospital privileges, insurance credentialing,
and the simple fact that doctors have belatedly learned that we can’t work 168-hour weeks and maintain our own health and family relationships
prevent us from being like our favorite docs of yesteryear.
Dr. Weinkle’s practice uses the concept of a “medical home”, often called the patient centered medical home, PCMH, which many medical offices are adopting, not just FQHC. But it is especially important with patient groups like the ones he and his colleagues care for.
He takes it one step further, writing we need more than medical homes, we need medical communities, where doctors work closely with their local hospitals, ERs, pharmacies, and schools to address patients’ needs.
Dr. Weinkle’s baby girl patient seems to be enjoying her visit. Photo by the girl’s father, used here by permission. When posted on Facebook, this photo received 4000 likes in one week.
Promoting health behavior change without insulting or scaring patients, by learning what obstacles they face and helping to resolve them
Honesty about disease outcomes, especially at the end of life; avoiding futile care, and recognizing that sometimes death is not a complication but is the ultimate outcome of some illnesses
“Activated patients” determined to get better, to do something about their illnesses, becoming experts on their diagnoses
Doctors and patients valuing and respecting each other’s time and knowledge
Cutting waste- eliminating those things we do in healthcare that don’t add value to care, making it safer or more effective; bureaucratic policies, procedures, and rules that waste both time and money, like prior authorizations, “utilization review”, and 15 minute appointments
Medical education that includes teaching interpersonal skills, with learning objectives given as much importance and time as other medical skills,
Ultimately, Dr. Weinkle wants to see medical care return to being
meetings between two human beings, together forming a covenant to achieve healing
That concept is partially born out of Dr. Weinkle’s Jewish roots discussed in the Appendix- Being a Nice Jewish Doctor
“God forms a covenant—many covenants, actually, sealing the promises with symbols like rainbows (Genesis 9:13), circumcision (Genesis 17:10), and stone tablets engraved with the law (Exodus 24:12).
The essence of the Jewish faith, the place where a Jew’s worth as a person is tested most thoroughly, is in the relationship with God—and the parallel relationship with other human beings made in God’s image. ”
What he sees beyond COVID-19
In the blog post I referenced earlier, Dr. Weinkle sees hope there too.
Two years ago, I approached… from the view that wholeness, completeness, was our natural state,… I believe the opposite now – the world began as chaos, as shock and confusion. The miracle of the universe is that anything beyond that even exists – anything we have is a gift. The comfort I take is that the one thing older …, the thing that hovered over even the unformed universe, was the rucha d’rachamin, divine mercy, and it shines light even before anyone has “let there be light.”
Dr. Weinkle
Why you should read HEALING PEOPLE
Health care professionals will find Dr. Weinkle’s concepts an attractive alternative to “burnout”, an encouragement to remember why we entered the profession in the first place, and a challenge to restore the personal touch that makes medicine truly an art.
Patients will find explanations about why medical care is at times fragmented, uncoordinated, and unproductive, will understand the challenge that their own physicians face in providing effective care, and understand how they can be part of the solution.
The book concludes with an extensive list of Notes listing the references used in each chapter and an exhaustive list of References and Suggested Readings, a few of which I will include below.
Here is a link to Dr. Weinkle’s website where you can read excerpts from the book and find a link to his blog post Winds of Mercy
You may recognize Dr. Weinkle’s practice location as one that made headline news a few years ago.
Squirrel Hill is considered a historic center for Jewish life in Pittsburgh. It is home to more than a quarter of Jewish households in the Pittsburgh-area, according to a Brandeis University study of the Greater Pittsburgh Jewish community.
I had only exchanged one email with Dr. Weinkle so it wasn’t until a few days later that I made the connection. I wrote to him and was relieved to learn he was safe. He had attended a Bat Mitzvah there just the week before the attack. Some of the victims were friends and colleagues.
watercress words by Dr Aletha 