The combination of speculative scaremongering by national health authorities and increasingly absurd directives to GP surgeries in response to the current flu outbreak confirm that public health has become a public nuisance.
In July this year health minister Andy Burnham announced that the swine flu pandemic could no longer be contained and there could be 100 000 cases a day by the end of August.1 In response to the suggestion from a TV interviewer that this could mean 40 deaths a day, Chief Medical Officer Liam Donaldson agreed that this was possible, and that it could be higher.2 Burnham conceded that his figure was ‘a projection’ not a fact — he meant that it was a speculation based largely on ignorance, similar to previous (unfulfilled) predictions of catastrophic mortality from AIDS, ‘mad cow’ disease and bird flu. Though leading public health authorities cling to the belief that proclaiming nightmare scenarios is useful in raising public awareness of disease, in reality this provokes anxiety out of all proportion to benefit.
On the same day we received in the surgery, by fax and e-mail (and no doubt shortly also by post) the latest of the almost daily pandemic flu briefings from the PCT. The headline barks: ‘PPE procedures to be used for every patient’. The bulletin continues in the now familiar tone of an exasperated infant school teacher spelling things out for children who suffer from a combination of learning difficulties and attention deficit hyperactivity disorder (though it never goes so far as to explain that PPE stands for Personal Protective Equipment):
‘GPs are reminded that on seeing a patient with flu-like symptoms they need to follow all guidance on PPE, including wearing a surgical mask, gloves and apron.’
This is the sort of advice that could only be given by somebody who has never set foot in a GP surgery, certainly not since the onset of the great swine flu scare. The simple fact is that many patients who have been alarmed by the pandemic propaganda take no notice of the advice to stay at home and come to the surgery (bringing their children) and — quite understandably — expect to be seen. So, after they have sat in the waiting room for hours, coughing and spluttering, we are then expected to scrub and gown up as though we were performing open heart surgery and then repeat this procedure for the 20 other patients in the queue? Dream on.
I am torn over what has been the most useful guidance we have received from on high. Is it the diagram showing a cross-section of the nasopharynx illustrating how to take a throat swab? Or is it the picture of the container showing how to package the swab for transport to the laboratory? It was also very helpful to receive ‘real examples’ of ‘what not to do’ detailing just how stupid some local GPs have been in misinterpreting simple guidelines. It is shocking to hear that some GPs have even confused WHO pandemic alert algorithm S5a (for dealing with suspected cases) with algorithm S5b (for sporadic cases). Is it any wonder that the pandemic is out of control? Can revalidation come a moment too soon?
The ascendancy of public health over primary care revealed in the swine flu scare is an ominous trend. The statements of both national and local public health practitioners confirm attitudes of condescension, even contempt, for patients and GPs. For public health specialists, our patients are merely people committed to unhealthy lifestyles. Their risk factor epidemiology repackages old prejudices: people get ill because they are idle, promiscuous, gluttonous, drunken, and as the spread of swine flu confirms, dirty. They regard GPs as sadly lacking in the moral fervour required to transform the deviant behaviour of our patients.
The moralising propaganda of public health has a generally demoralising effect on society, encouraging fear and anxiety — and attendant sentiments of stigma and blame. It has a degrading effect on medical practice and is corrosive of good relations between doctors and patients. As the swine flu scare confirms, it is also disruptive of day-to-day medical practice.
- © British Journal of General Practice, 2009.