Should this EP have prescribed an anti-viral therapy?

A 40 y/o female presented to the ED on a fall evening with the complaint of generalized malaise, cough, and congestion.

In triage, the patient’s vital signs were: BP 153/94; P 101; R 18; T 99.7; SaO2 97%RA. The triage nurse noted that the patient stated “feels like before with pneumonia.” She was triaged to the “fast track” area of the ED where she was evaluated by the emergency physician on duty.

The patient was a nonsmoker. Past medical history included one episode of pneumonia, but was otherwise negative.

The patient reported a 2-3 day history of flu-like symptoms, including body aches, runny nose, nasal congestion, mild shortness of breath, and a cough which was occasionally productive of clear or yellow phlegm.  Although the patient reported feeling warm or having chills on occasion there was no documented fever. The patient also denied sore throat,  difficulty swallowing, and chest pain.

Physical exam was unremarkable. The patient was not toxic, dehydrated or acutely ill, and the lungs were clear throughout.
A chest x-ray was obtained. The emergency physician documented that there was some “patchiness” in the left lower lung field, but concluded that there was no acute infiltrative process.  The emergency physician’s final impression was “Acute viral syndrome.”

While in the ED, the patient was given Motrin 600mg po, and Tessalon 200mg po.

The patient had a family physician and was instructed to followup in two days or return to the emergency department if her condition worsened. She was discharged with prescriptions for Vicodin, Tessalon Perles, ibuprofen, and Claritin.

The patient was discharged approximately 90 minutes after arrival.


Question:  For the sake of this case, assume that the diagnostic impression of acute viral syndrome is correct.  The focused question is whether the emergency physician failed to meet the standard of care by deciding not to prescribe an anti-viral therapy such as Tamiflu.

Select “I Agree” if you believe the care was “reasonable and within the standard of care.”  The physician’s decision not to prescribe anti-viral therapy was reasonable and therefore complied with the standard of care, i.e. the physician was NOT negligent.

Select “I Disagree” if you believe the care was negligent.  The physician should have prescribed anit-viral therapy.  Failure to do so was not reasonable, and therefore did not comply with the standard or care, i.e. the physician was negligent.