Eighty Gouty Patients

A man’s foot began hurting one evening. By the following morning pain was excruciating.

That sounded like gout, one of my favorite diseases. The diagnosis is easy, and I can quickly make it better. What’s not to like?

I carry a treatment for gout, but once I hand it over, I have to remember to restock my bag. So I went to my drug closet, made up another bottle of pills, and threw it in my pocket. 

Sometimes I’m surprised when I arrive at the hotel but not this time. He had gout. I produced the pills from my pocket, and everyone was satisfied.

It occurs to me that I’ve seen so many victims – this was my 80^th – that I can check the experts. They claim that it attacks men overwhelmingly. Sure enough, only seven of my patients were women. They say it’s a disease of older people. 67 cases were over 40, none under 30.

Until a few years ago, treatment was a powerful anti-inflammatory drug such as indomethacin which produced unpleasant side-effects. Then experts decided a large dose of cortisone for a short period worked as well with less unpleasantness. I already carry an identical course to treat severe poison ivy. Patients feel better within a day.

Should I Make a Housecall?

Only half my callers require one.

As I repeat, I’m happy to phone a pharmacy when guests forget legitimate medication: blood pressure pills, heart pills, contraceptives, etc. I don’t do this for guests who tell me “I had the same thing last year, and my doctor prescribed……” 

Exceptions exist. If a caller has had gout I believe him. It’s acceptable to treat a young woman with a typical bladder infection over the phone. If you’re wondering about symptoms of a “typical” bladder infection, I’m not telling. You have to tell me. Most “my doctor prescribes...” calls concern upper respiratory infections where the guest has received the traditional placebo antibiotic and believes he needs another.

Guests with stuffy ears don’t object if told they need a housecall, but I resist the temptation because ordinary congestion causes bilateral ear discomfort without pain. Over the phone, I advise aggressive use of nasal spray before takeoff and before the plane descends.

Injuries can be tricky. A doctor’s exam rarely diagnoses a fracture, but most common injuries are not urgent, even when a fracture is present. If guests are willing to wait until business hours, I can send them to an orthopedist’s office, more civilized than an emergency room. For back pain, a housecall is better. If you go where there’s an x-ray, you’ll get one, and experts agree that back x-rays are almost never helpful.

Much of my decision on making a housecall depends on the law of averages. Chest pain in a fifty year-old is usually not serious, but it’s unwise to assume this. It’s less unwise in a twenty year-old. A sore throat in a child or adolescent might be strep which medical science can cure. After age fifty it’s almost unheard of. I’ve never seen a case.