Background
Pandemic influenza has proven to be a difficult issue for health professionals throughout the world to combat. Pandemic outbreaks including the Spanish Flu, Asian Flu and the recent Swine Flu outbreaks have caused fatalities throughout India. A project was developed in which physicians from Sholapur city in Maharashtra were interviewed to develop a better understanding of how Indian physicians diagnose and manage flu patients. Indian physician attitudes to the development of clinical guidelines during the time of pandemic influenza outbreaks was also sought.
Purpose
The co-existence of different types of medical systems (medical pluralism) is a typical feature of India’s healthcare system. For conditions such as influenza-like illness (ILI), where non-specific disease signs/symptoms exist, clinical reasoning in the context of medical pluralism becomes crucial. Recognising this need, we undertook a qualitative study, which explored factors underpinning clinical decisions on diagnosis and management of ILI.
Methodology
The study involved semi-structured interviews including clinical vignettes with 20 healthcare practitioners (working within allopathy, homeopathy and Ayurveda) working in the private healthcare sector in Solapur city, India. An inquiry was conducted into criteria influencing the diagnosis, treatment, referral to specialist care and role of treatment guidelines for ILI. Thematic analysis was used to identify aspects relating to ILI diagnosis, treatment and referral.
Findings
The diagnosis of influenza was based largely on clinical symptoms suggestive of influenza in the absence of other diagnoses. Referral for laboratory tests was only initiated if illness did not resolve, generally after 2–3 consultations. Antibiotics were often prescribed for persistent illness, with antivirals rarely considered. Some differences between practitioners from different medical systems were observed in relation to treatment and referral in case of persistent illness. A combination of analytical and intuitive clinical reasoning was used by the participants and clinical decisions were based on both social and clinical factors.
Conclusion
Clinical decision-making was rarely a linear process and respondents felt that broad guidelines on influenza that allowed doctors to account for the sociocultural context within which they practised medicine would be helpful.
Financial and technical support
The study was conducted with generous financial support from the University of Nottingham, UK and HMF received technical support from Maharashtra Association of Anthropological Sciences, India.
The research team:
1. Dr Anand Ahankari worked as a Primary Investigator for the project with additional inputs from Mr Faraz Khan
2. The study was initially conceived and designed by Puja R. Myles, Anand Ahankari, Abhay Kudale, Sachin Atre, Manpreet Bains and Tessa Langle
3. Manpreet Bains and Puja R. Myles analysed the data
4. Sandro Tsang led on the theory-building with contributions from Puja R. Myles.