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/

The post Three Walk-In Clinics, No Family Doctor and One Patient with Abdominal Pain appeared first on Your Health Matters.

The Question: Is it the family physician’s job to gather test results and explain the outcome of those tests – blood tests, ultrasounds, X-rays and CT scans – and offer options going forward? Every test I have had, the results are sent to my family doctor, yet he says it is not his job to explain it to me and offer solutions or options. Half of the tests are missing or have not arrived at his office. There is no follow up. Every time I see him it is like the first time but he has been my primary caregiver for 25 years.

The Answer: You raise a very good question: Whose job is it to communicate test results ordered by one physician and conducted by another? If, as you point out, the test results go missing, you have no way of knowing and may assume [wrongly] that there was a negative finding and all was well. It is for that reason, it is important to ensure that the loop has been closed on every test result.
According to Jocelyn Charles, Chief of Family and Community Medicine at Sunnybrook, a physician who orders a test – for blood, ultrasound, X-rays or CT scans – is responsible for responding to abnormal results and communicating these results to the patient.

“Specialists are expected to communicate their assessments, test results and recommendations to the patient and the patient’s family physician,” wrote Dr. Charles in an email. “The family physician can only discuss results from specialists if they are forwarded to him/her, ideally with a recommendation about any further investigations or treatment.”

Ultimately, it is the responsibility of hospitals, laboratories, radiology facilities and specialists to ensure that family physicians receive results and information pertaining to their patients in a timely manner, she said.

As the family physician has no way of knowing what tests were done by the specialist unless this was communicated to them, Dr. Charles suggested patients call their family physician before their appointment to ensure test results have been received.

In addition, patients can request the specialist’s office, hospital or laboratory to forward the results to their family physician prior to their appointment. Ideally, this should not be necessary, points out Dr. Charles, who said efforts are underway at Sunnybrook to improve accountability for timely communication of information to family physicians.

Frank Martino, president of the Ontario College of Family Physicians, suggested patients remind the specialists that test results should be sent to the family doctor, providing the address if necessary right at the appointment time.

He pointed out that it is incumbent on him, as a family physician, to learn the results of any test he has ordered on a patient.

“I have concerns about this patient’s problem not getting the results,” said Dr. Martino. “And a physician who says it’s not my job to explain things to you. That’s part of the relationship.”

However, not every negative result – a test that has normal findings – needs to be communicated. There are, however, exceptions to that rule: the test ordered was due to a screening test, a suspected cancer, a biopsy, a bad diagnosis such as diabetes or anemia or a condition where symptoms have persisted, suggesting the need for more and different medical investigations to help aid in a diagnosis. In those cases, even though the test has not found anything, it’s vital for the physician to close the loop.

“It’s extremely important to communicate with your patient,” said Dr. Martino. “If there’s a particular test with a particular complaint, such as knee pain, then we go back to the blackboard, and come up with a plan for diagnosis.”

Tracking results, he points out, is not a simple matter and he is particularly concerned about these missing test results you mention.

“What we hope is that physicians have a process in place to reconcile test results that have been sent out to be done,” said Dr. Martino, who is a member of Queen Square Doctors family health team in Brampton. “And we hope that is a strong and fulsome system. Certainly, for critical results, there should be a system in place to reconcile those and act on them.”

I, too, am particularly concerned about your missing test results and for that reason I would suggest you contact your family physician to follow up. That may also be a good time to discuss how you are able to learn of test results with abnormal findings. I would also follow the advice of Dr. Charles and to call ahead of your appointment to ensure test results have been received and to request the specialist, hospital or laboratory fax or send these results to your family doctor.

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