The new flu, the so-called H1N1 strain, has certainly landed with a bang. My own experience with it thus far is that it doesn’t appear to be much worse for the individual child than “usual” seasonal flu — every year we have severe cases in the PICU — but the degree to which disease from this strain is compressed in time is remarkable. That is, it is causing a huge number of infections in a very brief time period. This probably is because the pool of susceptible people includes pretty much all of us because this strain is so new.

Still, we have had several cases already in the PICU and I expect to see more. Nationally, 11 children died last week from flu; there have been 95 such deaths since last April. The very best place to get updated news of the epidemic is from the Centers for Disease Control in Atlanta. Their influenza monitoring site is here.

Last week there was a notice in my mailbox from the pharmacy telling me that an antibiotic intensivists use frequently, vancomycin, was in extremely short supply. We still have some, but we were instructed to watch carefully how we use it until the shortage abated. How long would that be? It shouldn’t be too long — just a couple of weeks. Actually this sort of thing happens all the time. Brief (usually), unanticipated shortages of drugs are common.

The causes of the shortages are typically some problem at the facilities that manufacture them, and often there are only a few of these. Sometimes the cause is a sudden huge spike in demand, such as we saw for the antibiotic ciprofloxacin (Cipro) a few years ago during the anthrax scare and are now seeing with oseltamivir (Tamiflu) with the current influenza outbreak, but usually the cause is just some glitch in the manufacture of the drugs. Sometimes only a single facility is making a drug. This is particularly the case if the drug is a cheap generic, one for which the manufacturer doesn’t stand to make much money. Further, there generally are no stockpiles in case of emergencies like this.

If you are interested in learning which drugs are currently in short supply (and why), the American Society of Health-System Pharmacists keeps an ongoing list here

Here’s a recent piece I wrote for an excellent site aimed at fathers — Smartman Daily.

Fifty years ago it was nearly always mothers who brought children to the doctor. Things are different now. A child’s father is as likely to be the one to make the trip (and put up with those long spells in the waiting room). Whichever parent brings the child in, chances are the visit requires taking time off from work. Insurance co-pays continue their relentless increase, but one of the biggest costs to families is a hidden one–your time. So here are five ways you can make the trip to the pediatrician more efficient and useful to you and your child. One or more of these might annoy your pediatrician, but don’t be dissuaded. You’re not being a pest–you’re being a good dad.

1. Ask the doctor to explain exactly what he is doing during the examination. If you’ve watched carefully as a doctor examines your child, you’ve probably noticed it’s not a random process. There is a method to it. We’re looking for specific things when we shine a light down the throat, feel the front of the neck, or push on sore bellies. These things are often not mysterious, and parents can learn about them, too. No, you shouldn’t be using a stethoscope to listen to your child’s chest or an otoscope to look into his ears, but there is a lot of practical information you can glean from understanding how a doctor’s physical examination proceeds and why. So don’t be afraid to ask the doctor to show you what he’s up to. If you do, you’ll get much better at describing your child’s problems. That will help speed things up at the next visit to the pediatrician-and reduce the risk that the doctor will overlook something important.

2. Insist that the doctor gives a precise and understandable explanation of his conclusions. Making a medical diagnosis is a mixture of science-based decisions, educated guesses, and occasionally just speculation. When the doctor tells you what she thinks, ask her why–and how solid her conclusion is. Pin her down. If you don’t understand what she is saying–if her answer is full of jargon, for example–ask her again. Have her draw a picture or two, if necessary. Ask the doctor to think out loud for you about her decision-making. If you do that over the course of several visits, and pay attention to the process, you can actually learn yourself how to make some simple medical decisions. I’m not suggesting you try to practice medicine on your child. But the more you know about how doctors decide things, the more productive your doctor visits will be. You might even avoid a visit or two in the future.

3. Take notes during the visit, and review them with your doctor. We doctors take notes when we talk to parents, so why shouldn’t you take notes when you talk to them? It’s the best way to avoid misunderstanding. In particular, make sure you have the correct spelling of whatever condition or disorder the doctor describes to you. If he uses anatomical terms, make him spell those, too. You can then use this information to do a little research yourself afterward.

4. Tell the doctor you’re going to do some research of your own. Some doctors get annoyed when parents come to the appointment with a packet of information they found on the Internet. It’s true that there is a lot of misinformation out there-and this is precisely why a savvy parent should quiz the doctor about what Internet resources she recommends. Many doctors these days have handouts for parents suggesting where to look, but many also do not. So ask, then go yourself and learn. Sites maintained by children’s hospitals or organizations, such as the American Academy of Pediatrics or the American Academy of Family Physicians are examples of reliable sites.

5. Ask the doctor about e-mailing one another. Many doctors have embraced the benefits of electronic medicine. E-mail can be a huge time-saver both for you and for your doctor. From my perspective, e-mail is better than getting constant telephone calls that interrupt whatever I’m doing. If your doctor seems resistant to emailing with you, press him a little. You probably can save yourself the time and expense of a few office visits.

Doing any or all of these things may annoy your pediatrician. Yet medical practice in general needs some new ways of doing things, since at least part of the reason we are in the middle of so much health care turmoil stems from the traditional ways medicine is practiced. The way to think of your visit to the doctor is a team meeting of equal partners in your child’s care. Acting on these suggestions means that you are doing your part to educate your fellow team member, your doctor. Good doctors learn from parents all the time!

Opponents of the current proposals in Congress for reforming healthcare have asserted that nearly all physicians are in opposition to these measures. I’ve even read claims that physicians will leave practice in droves if any of these bills pass, leaving America short of doctors. The highly respected Robert Wood Johnson Foundation recently surveyed physicians to see how we actually felt about reform. You can read the summary of their findings here. The bottom line — a large majority of physicians favor reform.

The survey found that 63% of physicians supported a public option — a system in which there was a government-funded alternative to private insurance. More radical than that, 10% supported a straight-up single payer system, such as Canada has. In sum, this is three-quarters of America’s doctors. In addition, a majority (58%) supported lowering Medicare eligibility to include 55-year-olds.

The survey does not address reasons doctors think this way. I think a majority of them, like me, realize our current non-system is unsustainable financially. I also think it is immoral socially, but I may be in the minority on that one.