Three Walk-In Clinics, No Family Doctor and One Patient with Abdominal Pain

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 We drove across town to a third clinic only to find it closed entirely (out of date website maybe).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. Below is a link to Health Care Connect, which helps Ontarians without a family health care provider find one. http://www.health.gov.on.ca/en/ms/healthcareconnect/public/