The Personal Health Navigator is available to all Canadian patients. Questions about your doctor, hospital or how to navigate the health care system can be sent to AskLisa@Sunnybrook.ca
The Question: Late one afternoon, my sister, who is in her 30s, started having bad stomach pains. She decided to wait it out a little. But, the pain persisted and at about 5 p.m., she decided to head to the walk-in clinic (newish to the city, she doesn’t have a local family doctor). She didn’t want to go to emergency because she didn’t think her issue was severe enough. I went with her to one walk-in clinic. While the hours on the door said open until 8 p.m., they were no longer accepting patients. It was packed in there! We went to a second walk-in clinic. They, too, were extremely busy and not accepting any patients. We drove across town to a third clinic only to find it closed entirely (out of date website maybe). So, if patients aren’t supposed to go to emergency unless it’s a real emergency and walk-in clinics are too busy to see people in the evening, what should we do?
The Answer: A leading cause of emergency department visits is due to abdominal pain. At Sunnybrook, it represents about 10 per cent of visits, according to Dr. Jeffrey Tyberg, Chief of the Department of Emergency Services. Abdominal pain is a “perfectly legitimate” reason to go to emergency and in fact, he sounded concerned your sister’s symptoms were such that she went to three walk-in clinics for help – all to no avail.
“Abdominal pain – especially in a woman – can be a serious problem,” Dr. Tyberg said in an interview. “You have to decide if it’s worth the wait. She was concerned enough that she went to three walk-in clinics.”
In your sister’s case, the cause of her abdominal pain could have been due to medical emergencies that could pose serious threats to her health and potentially threaten her fertility. They include conditions such as ectopic pregnancy, appendicitis, ruptured ovarian cysts and ovarian torsion.
“It can be something benign,” pointed out Dr. Tyberg. “But it can be something serious. Acute, severe, abdominal pain in a young woman is certainly a medical emergency and requires urgent assessment.”
Canadians make close to 16 million visits to emergency departments (EDs) each year, according to the Canadian Institute for Health Information. With abdominal pain being one of the leading causes – no precise figure is available – it constitutes a challenging component of emergency medicine.
Diagnosis is not easy and typically involves physical examination, internal examinations and an array of diagnostic tests. That’s largely because the causes of belly pain can be due to referred pain due as there are many different organs within the peritoneal cavity. Some causes include peptic disease, pancreatic, inflammatory bowel disease, gastroenteritis, biliary colic, myocardial infarction and a ruptured spleen.
Tools for examining abdominal pain are far from perfect. Though CT scans can rule out many life-threatening causes of abdominal pain and reduce the need for exploratory surgery, they sometimes don’t lead to a definitive diagnosis. They also expose patients to significant doses of radiation. Ultrasound, both at the bedside and in the diagnostic imaging department, can help determine or rule out important causes of abdominal pain, said Dr. Tyberg.
Many patients who go to Canadian emergency departments with abdominal pain leave with the comfort of knowing the cause is not life threatening but without knowing precisely what precipitated it.
While your sister was trying to be a responsible user of health services, if she visited three walk-in clinics, that was probably a sign the pain was severe enough to warrant a visit to emergency.
It would have been best if your sister had a family doctor who could have quickly seen her. Health Care Connect helps Ontarians without a family health care provider find one.
There is another service called Telehealth Ontario, where patients can obtain free, confidential advice from a registered nurse. It does not replace 911.
Another way to find a family physician is to wait until July when a new crop of them graduates and they are starting to build their practices and are open to new patients. A university’s department of family medicine, the college of physicians and surgeons in your province and in some cases, the health ministry will have that information. Below are some links to provincial sites and information on how to find a family physician.
Lisa Priest is Sunnybrook’s Manager of Community Engagement & Patient Navigation. Her blog Personal Health Navigator provides advice and answers questions from patients and their families, relying heavily on medical and health experts. Her blog is reprinted on healthydebate.ca with the kind permission of Sunnybrook Health Sciences Centre. Send questions to AskLisa@sunnybrook.ca.
The comments section is closed.
It is no secret that the current model of primary care is not working for patients pretty much anywhere in Canada. A call for change has been happening for over a decade but it comes at a snails pace and improvements difficult to measure. As a patient living with a serious long term illness I can’t understand why the necessary changes aren’t happening faster. Stop talking about it and do what needs to be done to improve healthcare delivery, starting with a collaborative care model where patients see who they need to see and it may be a physician but a nurse, physio therapist, pharmacist, pyschologist, maybe even a social worker or a patient/peer mentor. It’s time to start thinking outside the box
What a classic paradox a conscientious person in need of treatment often faces. How does one determine what is an acute condition needing immediate treatment from something more benign? There’s plenty of stories that come to mind about those close to me. A young female in her early 30’s reluctantly rushes herself to hospital from work with a bleeding ovarian cyst and is in emergency surgery within hours. A male in mid thirties with painful headaches is seen in 2 emergency departments, sent home 3 times and 40 hours later dies of a brain aneurysm.
What then does it mean for a patient to “err on the side of caution”? To benefit an overburdened system? After having suffered many instances of severe abdominal pain due to Crohn’s disease over the last 33 years, my advice to any patient is if you’re suffering acute abdominal pain for more than an hour and have no history of this type of pain, get yourself to a hospital. A walk-in clinic isn’t equipped for that type of event and would forward you on to the ED in any event.
Your story shows how effectively we’ve educated the public that they should seek care ANYWHERE besides an emergency department. Does this help patients? Does this save money?
Thanks, Shawn for your comments. You raise two very important questions. While this patient was trying to be a responsible user of health services, she had a terribly difficult time accessing care. It turns out the emergency was probably the best place, given that she could not obtain timely care.
I personally do everything I can to avoid the ER (to my detriment, sometimes: I walked on an undiagnosed tibia fracture for two weeks once) because so many times I or people I know have gone, it’s been 4-6 hours only to discover that there was nothing, medically, to be done. I understand that, for a variety of reasons, Triage can’t really turn you away, but sometimes it feels like there should be a front line exam that can happen in a reasonable time frame, with an escalation to a second line if necessary.
Family medicine shot itself in the foot when it became a “Specialty” back in the early 90s.
We need to go back to the rotating internship model, where every graduating MD has the clearance to practice real primary care. It would sure be better than the current system of trying to force family medicine on unmatched medical students, trying to recruit people more “likely” to do family medicine into its ranks (which include lots of demographics who value part-time work), and poaching foreign docs from third-world countries.
Our “shortage” problem stems primarily from this.