Clinical Scenarios

Scenario One While driving to work, Dr Robinson hears on the radio that there has been a marked increase in the past few weeks in the number of human cases of bird flu in Vietnam and Thailand. On arrival at his practice, Dr Robinson notices that the receptionist has put a box of surgical masks on the bench. The practice is busy. His four other partners are already behind schedule. Halfway through the morning, the receptionist knocks on the door. She is wearing a mask. Dr Robinson chides her for scaring patients. She replies that she is not taking the mask off. " Mr Brindol is out there, hasn't got an appointment. He is coughing and he has just been to Thailand. " She adds, " He is very sick, you should see him straight away. " Dr Robinson follows the receptionist into the waiting room. Matt Brindol is sitting among the patients. Lily Chatwa, due to give birth in 2 weeks, is sitting next to him. Matt Brindol is 26 years old. A triathlete, he is known to the practice for being obsessed with diet and fitness, and concerned about any minor injury. Dr Robinson is struck by Matt' s appearance. He is pale and sweaty, and coughing into a handkerchief. He is holding on to his chair with one hand as if he is afraid he will fall off. Matt tells Dr Robinson he returned from Thailand 2 days earlier. His illness started on the way back: sore throat and muscle pains. The cough started yesterday. His pulse rate is 98 beats/min, blood pressure 100/70 mmHg, and temperature 38° C. Dr Robinson rings the local public health unit, who advise him to collect nasal and throat swabs. The patient, Dr Robinson is told, should be isolated until the results exclude avian influenza. Dr Robinson puts on a surgical mask and gloves, takes swabs for viral studies, and rings the nearest laboratory for the courier service. He puts a surgical mask on Matt and says he must go home, and not see anyone until he is contacted. Dr Robinson tells him it is probably a cold virus, but they had better be careful as there is a slim chance it is bird flu. Three hours later, the laboratory informs him that Matt Brindol, on the first test, is positive for influenza A. They have already sent the sample to …