# 2204
Thanks to Crof over at Crofsblog for picking up on this story out of Australia. A synopsis is carried by Adelaide Now : GPs not prepared for bird flu pandemic.
The study referenced in this story appears in the eMJA, the Medical Journal of Australia. Here is the abstract, slightly reformatted for better readability.
Registration is free, and a simple matter, if you wish the read the entire article.
How will Australian general practitioners respond to an influenza pandemic? A qualitative study of ethical values
Olga Anikeeva, Annette J Braunack-Mayer and Jackie M Street
Abstract
Objectives:
To explore general practitioners’ perceptions of their preparedness for an influenza pandemic, the changes they would make to their practice, and the ethical justifications for their planned actions.
Design and setting:
A qualitative study was performed among South Australian GPs between March and October 2007. A semi-structured interview was carried out with each participant in his or her practice, and the interviews were audio-recorded, transcribed and analysed thematically.
Participants:
10 GPs were recruited: five from a metropolitan Division and five from a rural Division of General Practice.
Results:
Some participants felt they would not be able to cope with an influenza pandemic, while others felt it would simply mean an increase in their workloads.
Most respondents considered creating separate waiting rooms, moving the reception desk outside of the practice and delaying all non-urgent consultations in order to deal with a pandemic more effectively.
Respondents mentioned the conflict between their various roles and responsibilities as a primary source of tension when thinking about the way they would organise their work in the event of a pandemic.
A number of GPs said they would not practise in the event of a pandemic, as they felt their responsibility to their families outweighed that to their patients.
Conclusions:
Professional codes of ethics should include guidance about the scope of the duty to treat during infectious disease outbreaks. The community has to uphold the value of reciprocity, and ensure that GPs and their families are provided with support during a pandemic and are given the opportunity to be actively involved in pandemic preparedness planning.
The moral dilemma for health care workers during a pandemic remains largely unaddressed by most governments and health care facilities.
The assumption appears to be that, `of course doctors and nurses will work. It's their duty'.
This despite the fact that again and again we've seen polls and studies that indicate that a certain percentage of HCW's (health care workers) would be reluctant to work during a pandemic.
Quoting from this study, 30% of the doctors participating expressed reluctance to work during a pandemic.
However, three GPs gave quite different responses: they were hesitant to see influenza patients during a pandemic because they felt that their responsibility to themselves to stay healthy and to protect their families outweighed their responsibility to continue working:
I would try to see what I can do to work; it’s just that I don’t want to sacrifice my life. (P4)
I think that anybody that works in general practice has some sort of responsibility to their patients, but I would still say that my primary responsibility is towards my family. (P7)
Interestingly, 30% is roughly the percentage of nurses who have expressed a similar hesitancy in the allnurses.com pandemic poll that I've highlighted in past blogs including here, here, here, and here.
How many doctors and nurses, and their support staff, will continue to show up and work during a pandemic will depend on many factors.
The severity of the pandemic will be a major factor of course. The CAR (Case Attack Rate) and the CFR (Case Fatality Ratio).
But equally important will be the availability of PPE's (Personal Protective Equipment), the availability and effectiveness of antivirals (for HCW's and their families), and the security and safety of the workplace.
Governments and Health Care facilities have a duty to rigorously prepare for a pandemic, and protecting the health and well being of their staff (and their families) should be at the very top of their preparations list.
Most healthcare workers, I believe, want to work during a pandemic.
But few are going to be willing to sacrifice themselves needlessly on the altar of inadequate preparedness.
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