Nearly 5,500 calls came in to the Towson office of Dr. Sarah F. Whiteford in the month of October - more than twice the usual number. And even with extra staff manning the phones, about 1,000 patients grew tired of waiting and hung up.
It's a flu season like the office has never experienced. And despite the nearly overwhelming volume, Whiteford and other primary doctors say the phone has become their most essential tool in not only managing the first pandemic in decades but tamping down the widespread anxiety about the swine flu virus that has killed 13 people in the state.
For the sick, the doctors have used the phones to weed out the truly needy cases and to convince everyone else that they will get better with rest, Tylenol and fluids at home. For the healthy, they have used the phones to schedule appointments for vaccination, and to spread news when they have no more doses.
"Everyone has been helping answer the phones," said Whiteford, a family doctor from the Greater Baltimore Medical Center's Family Care Associates, which has several thousand patients. "October was really busy and November isn't shaping up to be any slower."
The phone system is set up to funnel swine, and seasonal, flu calls to receptionists. They can make vaccination appointments or take messages for the doctors. Other calls, such as for referrals or prescription refills, go to specific voice mail boxes.
Even with their system, Whiteford's waiting room one day last week was full within minutes of the door opening.
Some of the patients have been in rough shape, like Ken Kurz, who had been trying to weather the flu at home. He spent most nights in his Homeland bed staring at the clock, waiting for the next four-hour block to pass so he could take more medicine.
Still, he was getting worse. The pain of his congestion was so bad his teeth hurt. And he was worried about infecting his wife and 6-month-old son, who had not yet been vaccinated against the H1N1 virus. As he suspected, he had a secondary infection that required antibiotics.
But doctors say most patients do not need such prescriptions. And they don't need Tamiflu, the antiviral medication administered mainly to young children or patients with underlying conditions in the first couple of days of the flu to lesson the severity.
Most patients with the flu don't need to come to the office at all, and they don't need to go to the emergency room. Whiteford said those with no complications such as trouble breathing or severe dehydration and no chronic health problems such as asthma or respiratory disorders should stay home so they don't spread the disease.
Dr. Michael Randolph, a private physician who shares a 5,000-patient practice with another doctor at Union Memorial Hospital, said that while his call volume is up, people seem to have gotten the message about who is first for a vaccination and who needs to see the doctor. He said he has many patients with other health issues, and he does want to see them because they are more vulnerable to troublesome secondary infections such as pneumonia.
"That's who I'm really concerned about, but many people seem to be educated about when to call," he said. "Others who are calling and it's only Day 1 and they don't have a complication or an underlying conditions, I give them my Grandmother Rule: If you're not better in four or five days, call me back."
That, however, can be a tough sell for adults. It's an even harder sell for some parents, who have read about the high toll the virus has taken on kids, Whiteford said. Million of people have gotten the flu, and the vast majority recover at home with no problems. But two Maryland kids and more than 100 children across the country have died, though the U.S. Centers for Disease Control and Prevention reports two-thirds have had another health condition.
"A lot of people want to be listened to and examined," Whiteford said. "Sometimes it makes them feel better to be seen."
And doctors do want those with other health conditions to come in for an examination if they are sick or get a vaccination if they are healthy. Many doctors, though, don't have vaccine doses. Out of a stock of 400 doses, Whiteford had just a small number left of the nasal spray version of the swine flu vaccine, which can't be used on those with chronic health problems or young kids. She also had some injectable pediatric doses of the seasonal flu.
Other doctors have no H1N1 vaccine at all, including Randolph. He already blew through his doses, about 200, of seasonal flu vaccine even though that flu strain has not yet surfaced and isn't expected until December.
He's been telling people about public clinics offering swine flu vaccine for priority groups, which include pregnant women, infant caregivers, kids six months to 24 years, adults with underlying health conditions and health care workers.
The lack of vaccine has worried doctors, especially pediatricians, who have been working with the state to steer whatever doses they can to the most vulnerable children, said Dr. Virginia Keane, the president of the Maryland chapter of the American Academy of Pediatrics.
Parents are calling doctors across the state for the vaccine and Keane said most have none or very little, so they're trying to "ration very carefully so only the highest-risk kids get it." Children 6 months to 5 years and those with chronic illnesses need to get vaccinated before healthy high-schoolers, though the teens are also in the target group, said Keane, who is also an associate professor of pediatrics at the University of Maryland and a pediatrician for special-needs children in Maryland's Pediatric Ambulatory Center.
The state reported this week that while more vaccine is finally coming in - it had ordered more than 726,000 doses - 2.9 million are needed to cover people in all the priority groups.
Despite the lack of vaccine, Keane does believe the rush to doctors is slowing just a bit. She said other doctors tell her they are getting fewer calls lately from parents, who aren't as scared as they'd been early in the pandemic when a healthy 14-year-old girl died. And maybe more notably, the state is no longer requiring kids to have a doctor's note to come back to school after having the flu, she said.
For children, she agreed home care is all that's necessary for all but the very young and the sick. She said keeping children hydrated is the most important thing, even if that means serving them sugary drinks, normally a no-no, she said.
"Most people experience an illness like a bad three-day cold," she said. For anything unusual, "Talk to your doctor."
That's exactly what the Wingate family planned to do last week in Whiteford's office, though no one was sick. They called because 14-year-old Breia needed a checkup, but she was concerned about flu, having followed developments on the news.
She wanted the vaccine. So did her father, Terence, who now considers his job driving a bus in Baltimore a health hazard.
"People are coughing on me all day," he said. "I keep disinfecting spray with me and hand sanitizer, too. ... I had a doctor's appointment last week, but he was all out of vaccine. If they'd allow me to, I'd get the vaccines here, the seasonal and the H1N1."
When to call the doctor:
Those with underlying health conditions, young children and pregnant women are more at risk for complications from the flu, so contact the doctor with concerns. Healthy people with fever, sore throat and cough generally recover at home in a few days. But call the doctor if warning signs emerge:
* In children: Bluish or grayish skin, not drinking enough fluids, not waking up or not interacting, being so irritable that the child does not want to be held, flu-like symptoms improve but then return with fever and worse cough, fever with a rash.
* In adults: Difficulty breathing or shortness of breath, pain or pressure in the chest or abdomen, sudden dizziness or confusion, severe or persistent vomiting.
Source: the U.S. Centers for Disease Control and Prevention