February 14
When I woke up one night with a pain in the first digit of the middle finger of my right hand, my first impression was that it had to be gout. I had some gout flareups before and it always started with sudden pain during the night. The weirdest thing is that once it happened in Dawson City after we hiked the Chilkoot Trail in Alaska and the other time it happened in Chennai, India when we did charity work. Perhaps it happens during unusual and maybe stressful times, although I remember it happened at home, in Ottawa years ago as well. The usual treatment has been some anti-inflammatory tablets for a week. But not this time.
I wanted to see my GP but met a doctor substituting for her, whose first comment was that my swelled digit was a powerful middle finger to show someone to bug off – said in jest and taken as such. Then he sent me for an x-ray and gave me a prescription for anti-inflammatory medicine. And come back in two weeks. So far, so good. When I returned, I was scheduled with another doctor. She said the x-ray did not show gout and said I was on the right track. Then she examined all my fingers and toes and noticed that I had a toe enlarged by an accident a few years ago that never healed properly and looked like gout with puss oozing out of it. So she prescribed anti-biotic medicine for me and another anti-inflammatory to speed up the healing. Again, come back in two weeks. This third visit, with yet another doctor at the clinic, told me I was improving and took pictures of my finger and toe. The next time a fourth and again, a different doctor said that I was on the right track but sent me to a rheumatologist to deal with my gout for the long term and also noticed that one of my toes is pink, indicating perhaps that blood circulation is lacking and therefore sent me for an ultrasound test for my vascular system. Aha. I saw four different doctors, all subbing for my GP, sent me for tests, and prescribed medicine. Now you would consider that our medical system is great. And it is and was accessible for me; appointments secured quickly. But was I over-medicated? In previous bouts I have had with gout, a doctor gave me one prescription to reduce the swelling and decrease the pain and that was the end of the treatment.
I told the four doctors my history with gout; I had flareups once every five to ten years and in total not more than half a dozen times. And each time, they treated me with medicine that lasted a week. This time, the doctors treated me differently. Perhaps they intended to solve my recurring gout on a more permanent basis; if so, I did not understand why. I was wondering, though, about the cost to our medical system.
I was happy to get an appointment with a rheumatologist quickly but disappointed in having a remote consultation. I explained on the phone what my gout looked like but I would have preferred if the doctor saw me in flesh before prescribing a couple of medicines that I understood to be taken for life. This was another one of today’s health care practices: remote consultation. After the consultation, I read up on gout and found that diet has a major role and with an appropriate diet, one may reduce flareups. I would much prefer to use dieting to taking pills for life, and at least have the pros and cons of this more moderate approach explained to me.
The rheumatologist also sent me for a blood test to provide a base case for “uric” acid that triggers gout. The doctor probably assumed that my level of uric acid was high. Imagine my surprise when the results came back, showing that the level of uric acid in my blood was right in the mid-range of the acceptable level. When I inquired why to take pills when my results followed recommended levels, the doctor told me she would like to see the uric acid level further decline in my blood. It made me think perhaps I should have had the blood test first, based on which to prescribe the type and amount of medicine.
Healthcare was accessible to me and practiced by well-educated professionals. But I had a feeling that I did not have one doctor who knew me and my history and advised me accordingly. So each doctor gave me his/her best opinion and prescriptions, but continuity was not there. I thought that perhaps the first doctor who saw me should have taken the pictures that subsequent doctors could use in examining my gout. And I was quite willing to see the rheumatologist in person instead of remote consultation. But I was not asked if I preferred it. Frankly, I am confused about how our medical system is delivered; whether it is cost-effective, and whether it is patient-centered.
I consider myself extremely lucky to have seen five doctors in six weeks, triggered by a gout attack in the first digit of the middle finger of my right hand. This is when people are searching for general practitioners with a short supply of doctors and when elective surgeries are postponed because of Covid. I was given five prescriptions, sent for a blood test, an x-ray, and an ultra-sound. I was overwhelmed.
andrasthehun.ca 