Doctors' offices caught between the ill and the ill-tempered
Satisfactory answers are in as short supply as the flu vaccine itself, workers find

By Michael Laris
Washington Post Staff Writer
Sunday, November 1, 2009 9:53 PM

The staff at Capital Area Pediatrics is at the sharp end of the nation's vast swine flu vaccination push. They have been screamed at and cussed at, and some have gotten the virus themselves. One has already ditched the job.

"We are receiving an unprecedented amount of verbal abuse and threats to the staff at the front desk," Elizabeth H. Watts, the Northern Virginia practice's medical director, wrote in an urgent appeal to patients. "If we have staff quit, we will not be able to provide you with the service your family deserves . . . "

"Please do not yell at or threaten the staff in any way."

Parents clogging the phone lines seeking the vaccine are competing with hundreds of patients who already have swine flu, enraging both. Employees have ended up in tears. "They're just . . . they feel like they don't need it," Watts said of the stress.

For the past two weeks, thousands of people have been engaged in a fevered call-a-thon in the District, Maryland and Virginia, bombarding doctors' offices with queries even though doctors don't know when they will get more -- or any -- of the H1N1 vaccine. "It would be nice if it could be a more civil process, where we just walk into the office and leave," said Allison Evans, who called her pediatrician and obstetrician for weeks with no luck before lining up at a District clinic Thursday and waiting for three hours with her 3-year-old asthmatic son, James, and his stuffed panda.

But inside the doctors' offices, where the phones keep ringing, there are sick people to worry about. Watts said her practice's half-dozen offices from Falls Church to Ashburn have already seen hundreds of patients with swine flu. The Vienna office alone had 200 patients on a recent day, about half with the flu. Three doctors and some staff members have been laid up with H1N1. Although many have been immunized, some fell ill before the vaccine kicked in.

It's a confluence unlike any Watts has seen in 22 years. And it has turned the basic act of trying to be clear with patients into a minute-by-minute test.

The starting point is this: There's tremendous demand for limited vaccine, and the system for distributing it to private doctors' offices is opaque. It's not clear to the public or the doctors who is going to get what when.

Moreover, in a typical fall week, Watts and her staff would be racing through seasonal flu vaccinations about now. But because of the swine flu, she received only 20 percent of the seasonal flu vaccine she ordered and had to cancel clinics, irking patients. This flu season, there are more sick people now than at a normal year's winter peak. And the staff is simultaneously scrambling to immunize thousands against H1N1, shifting strategies on who is eligible after federal officials said production was slower than expected.

"It's all hitting together," Watts said. "And then parents are concerned and scared and want to do the best thing they can for their kids, so when they call, it takes a long time to answer their questions, which means that the sick people can't get through on the phone."

And when they finally do, that, too, might not be satisfying. The swine flu is generally mild, and for overall healthy patients, the advice is often "Stay home. You can take care of it at home" -- which can be infuriating yet perplexing. "In the same breath, we're saying we think everybody needs to be immunized to protect the population from this overwhelming pandemic. That's information that feels like it could be conflicting," Watts said. She has posted guidelines on her Web site, http://www.capitalareapediatrics.com, to try to help. She said that parents should call if they are worried about sick children but that doctors can't see everyone because they must have time to diagnose and treat the worst cases.

The doctors have a key role. In Maryland, about 60 percent of all doses have gone to health-care providers, a category that includes physicians' offices and neighborhood clinics, according to David Paulson, spokesman for the state's health department.

Officials say they divvy up supplies among pediatricians' offices, obstetricians and others who can reach those most at risk the fastest. Virginia officials have been allowed by the federal government to order more than half a million doses so far. They want more than 4 million.

"There's a void out there," said James Farrell, Virginia's immunization chief.

"Somebody takes her child to her pediatrician. The pediatrician has those 20 doses and vaccinates those children. A neighbor who has the same pediatrician calls, and the vaccine is already gone," Farrell said. "It's frustrating for the doctors. It's frustrating for his patients."

There is no immediate solution, he said. His message: There will eventually be enough.

But it's the doctors' offices that keep getting the questions, even while seeing the sick: When? And how?

"The answer is, 'I don't have an answer,' or, 'I don't have the answer you want,' " Watts said.

"It's the hopelessness of feeling like no matter what you say, you can't calm their fears about the H1N1 and flu in their children, and the fact that they want the vaccine immediately is one thing you can't fix," she said.

One Herndon client who called said she was abandoning the practice because her sick child wasn't being seen. In a dozen years, the office had never put her off, a nurse told her, asking her to reconsider. She eventually did.

Most of her clients have shown incredible understanding, Watts said. There have been plates of cookies for besieged staff, and in the days since sending what she now calls her "Be Nice" e-mail, they've received an outpouring of appreciation. There's still yelling, but "the volume has changed," she said. She's trying to keep staffers' moods up for the long haul, and eight more people have been hired to help.

At a clinic Saturday in Ashburn, Watts and her staff vaccinated those who signed up in time by e-mail. Away from the chaos of the daily practice, they covered 600 people. "It's a great job. I love it. It really is," she said. "This is what we do. We give immunizations. We don't do it halfway."

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