Fierce Q&A: Prepare your practice to handle a public health crisis

As of Tuesday, more than 100 people across the United States have been infected with--and 12 have died from--a fungal form of meningitis contracted from contaminated steroid injections used to treat pain. According to the Centers for Disease Control and Prevention, as many as 13,000 people may have received contaminated medicine, and the number of cases is expected to rise.

Physicians who may have distributed injections from the New England Compounding Center in Framingham, Mass., which has voluntarily recalled all of its products, are advised to follow guidance issued by the CDC on how to determine and address patients' risk for contracting the disease.

Meanwhile, potentially affected patients are left anxiously assessing whether they're experiencing symptoms of meningitis, which range from neck stiffness to sensitivity to bright light. "Even if symptoms seem mild, call your doctor anyway," CNN advised.

Although this particular outbreak will affect a very small number of practices, such as those that specialize in pain management, similar scenarios can and do occur in all types of healthcare settings. Pediatrics, for example, is particularly prone to managing fast-erupting public-health concerns and crises.

To provide insight into how all types of practices can prepare for and handle such situations, FiercePracticeManagement spoke to Jesse Hackell, M.D., (pictured right) vice president and chief operating officer of Pomona Pediatrics PC in New York, and Scott Needle, M.D., a Florida pediatrician who is also member of the American Academy of Pediatrics' (AAP) Disaster Preparedness Advisory Council and consults with the Pennsylvania Chapter of the AAP on ways to increase communication and partnership between public health and primary care pediatricians.

FiercePracticeManagement: What's the first step practices should take in managing an outbreak crisis?

Hackell: Get your facts straight. You don't tend to get most of these things through official channels at first.


"The physician has got to be proactive in locating the actual facts because what comes across in the press is not always factual."

The most recent thing that hit us was a concern about arsenic being present in infant rice cereal. There were published reports, and we started hearing about it. Only after that, did we start to get some statements from the FDA. The physician has got to be proactive in locating the actual facts because what comes across in the press is not always factual. And even if it is initially, it's a lot like playing a game of telephone as the information gets passed along, especially through the Internet. If you don't have time to get a handle on the details immediately in the middle of the day, you may have to tell the patient, "I don't know," and call back after you find out.

Needle: One of the first things everyone can and should do is sign up for alerts from the CDC, as well as state and local health departments so you get your information as it breaks from a trusted source. Emails from the CDC, for example, include not just a summary of the news to date but also recommendations for clinicians and patients.

FPM: With an event so widespread and potentially serious, how should a practice communicate necessary information to patients?

Needle (pictured right): In almost any kind of public health crisis that comes up lately, I think back to H1N1, when so much information was unknown and quickly evolving. Hopefully, a lot of practices have started to improve their communications after that, both in terms of how to receive and process information that's coming in, but also in terms of communication to patients and advising them on what they can do.

An influx of calls to the practice is going to be inevitable. Make sure everyone in the practice is on board and has a plan to deal with it. For instance, are you going to have a recorded message offering basic info and advice? Are you going to institute phone triage at the front desk or set up a special nurse line? Think about not just how to handle the volume of calls, but what you're going to say and listen for, so you know when to have patients come to the office, send them to the ER or simply provide reassurance.

FPM: According to some of the local news stories about the meningitis outbreak, it seems that physicians have a tough job in managing concerns of patients who may not be at high risk or having symptoms.

Hackell: With something as dramatic as the meningitis scare, that is a tough issue. Not too many people are going to want to volunteer for a spinal tap when they have no symptoms. You've got to give them guidelines to monitor themselves. A lot of illnesses, such as Lyme disease, come with guidance to look out for flu-like symptoms; that's so vague as to be useless. You've got to be a bit more useful in what you're telling people to look for so they can be more specific and focus in on the real potential signs and symptoms that may be an indication they need testing or treatment.

FPM: What are some of the major pitfalls to avoid in managing a public health crisis in your practice?

Needle: The first mistake to avoid is simply not having a strategy. The more planning you do, the less stressful it is going to be for you, your staff and your patients, and you'll be able to handle what needs to be handled in the right setting.


"Once you start making guesses or repeating rumors, you may lose your credibility."

The next caution is to remember your responsibility to maintain credibility. Practices have to be honest. If they don't know something, they have to let people know that they'll continue to communicate information as the situation develops. Once you start making guesses or repeating rumors, you may lose your credibility and patients aren't going to come to you as a trusted source anymore.

Hackell: You can make mistakes at two ends of a spectrum. Blowing it off too casually causes two problems. If you tell people it's not a big deal, and it is a big deal, for example, you've really done a disservice. But even if it turns out not to be a big deal, you've demonstrated to a patient or parent that you're not intensely concerned with something they're worried about, rightly or wrongly.

On the other hand, you don't want to cause too much alarm. You've got to tread a fine line and modulate your response based on keeping people alert and aware without panicking them.

Editor's Note: This interview has been edited and condensed for clarity.