Why we all need to stop getting hot under the collar over mild fevers


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By Dr Livingstone
GP

16 Aug 2018

This is a brief story of fever, anxiety and misinformation. It also provides an insight into why the NHS is so busy and so strapped for cash.

A mum phones 111 about her feverish child and is directed to the local out-of-hours (OOH) centre. She explains that she’s worried because her other daughter once had a febrile convulsion. She’s given advice about fever control. She visits the pharmacist to stock up on paracetamol.

Her child’s fever doesn’t seem to improve. The next day she decides to attend A&E. There she is lectured on the importance of getting the temperature down and ibuprofen is advised. She goes to another pharmacy to shell out for some more anti-pyretic cash. Next day, the child is still febrile and ends up in my Monday morning emergency surgery.

At which point, it’s time to give a little detail. The child is four years old, a bit sniffly and is well enough to be dancing around my room emptying my drawers and trying to stick her hand in my sharps bin. Mum looks on, a picture of anxiety and frustration, commenting that, ‘She still has a fever’. And so she has. Of 37.8, obtained in the few seconds she remains still before resuming her blitz of my consulting room.

By this point, this child has seen five different health professionals and spent many hours oscillating between 111, emergency primary care centre, pharmacies, A&E and my surgery, and all the while has been manifestly well. Apart from a cold and a fever.

Now, I’m not trying to be clever. But I’d say that this scenario could have been sorted with one phone consultation, or at most one face-to-face appointment. Yes, the mum’s anxiety played a part, but then no one had allayed it.

If only someone – OOH nurse practitioner, pharmacist, doctor – had simply pointed out that:

  1. You do not need to ‘fight a fever’
  2. Fever is a normal part of a viral infection
  3. The only relevant issue is ruling out any serious cause for the fever, which was clearly not a concern here as the child was so well
  4. Current guidance is only to use paracetamol or ibuprofen if the child is unwell or distressed, not just for the fever itself
  5. Anti-pyretics do not prevent febrile convulsions which, though distressing, are harmless anyway

….all of which are true (check this out if you don’t believe me) then a whole lot of hassle, time and resources would have been saved.

Explaining this took a bit of time, largely because of all the unravelling of previous advice it entailed. But she left happier, and her daughter left a trail of destruction.

So before we blame the public for being health illiterate and creating unnecessary work, let’s get our own facts straight first, shall we? Perhaps that way, those Monday mornings might seem a little less febrile.

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