Case report: How long?

It is interesting to consider the duration of a problem with which a patient presents for diagnosis. Some things i.e. very recent injuries, bleeding etc. prompt rapid consultation. This is especially true at our walk-in clinic on weekends or when patients can’t obtain a timely appointment with their family physician—or do not relish the thought of waiting hours at urgent care.Depending on anxiety regarding the nature of a problem—say a rash—or concern about missing school or work, some issues are presented within hours or days. A persistent cough or sore throat, are usually tolerated for a while. Less commonly—for various reasons—patients will be seen about a longer standing issue.Read: Case report: A frustrating rashRecently, a pleasant, shy, 21-year-old woman came to our clinic with a rather unique problem. Having been born in India, currently in Canada since 2022 on a student visa, and having no health insurance, at the urging of her partner, she decided to ask about a lesion on her left hand. The raised, slightly tender, enlarging bulge had been present for ten years—never shown to a doctor or treated in any way. As seen in the picture, the marked protrusion on the dorsal aspect of her hand, at or just proximal to the metacarpal/phalangeal joint of her thumb, had not been a problem—except now due to appearance.I was fairly certain that with a ten-year history (about the longest I could remember), the lesion was either a ganglion (tendon sheath cyst) or joint cyst. Not urgent—but requiring some definition. The patient anticipated having OHIP within a few months. That made the treatment decision much easier. I discussed the situation with the patient and her partner—agreeing to minimize cost, by obtaining an ultrasound to confirm my diagnosis, deferring an unnecessary follow-up appointment with me, and then waiting until she had OHIP, at which time her doctor visits (especially if a consultant such as plastic surgeon were required) would be covered.Seeing many students who are immigrants, young and have no medical coverage, I was reminded of how fortunate most Canadians are—and to keep potential accessibility and costs in mind when treating those who are not insured.Robert Dickson is a family physician in Hamilton. This report is based on a real case from Dr. Dickson’s files.

Case report: How long?

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