Case report: Wait times

A common theme voiced by patients who come to our walk-in clinic for urgent care, is the unacceptable time required to access their family doctor or care in an emergency department. We try to minimize waiting from hours, days and weeks—down to a few minutes. A rather puzzling, unpredictable and enormously variable, self-determined waiting time is reported by patients who are seen at our clinic regarding issues which began anywhere from 10 minutes to 10 years previously. Many factors influence a decision—understandably short delays—following an accidental injury (feared to involve a fracture) or significant laceration. Despite the usual short delay between recent trauma and obtaining medical care, there remain the enigmatic scattering of patients whose problem would not seem to concur with the delay in seeking medical advice.This small group was typified by a recent appointment with a 33-year-old, shy, tentative, anxious, fair-skinned young woman, with no underlying illness, no allergies and taking no medications. Accompanied by her shy, anxious husband, she offered her very heavily bandaged right hand for assessment. She had burned her right palm on a curling iron, over a week previously, sought no care, but applied a series of over-the-counter products (Bactine Plus, Polysporin and 1% Hydrocortisone cream) with no improvement. In fact, the lesion was becoming more painful and surrounded by a red periphery (see picture). The couple wanted advice on how to manage the obvious large blister. They were concerned that treatment would be painful. Diagnosis was straightforward—a blistering burn. The tender periphery could have resulted from incipient infection or simply the traction stress of the blister. A one-second perforation of the blister with a sterile needle achieved instant relief of much of the pain and eliminated the blister. It was unfortunate that the patient had delayed seeking treatment. A short course of Amoxil was prescribed and a tube of Fucidin antibiotic cream (at their insistence, to replace their collection of OTC products). A less bulky, clean dressing could be used temporarily (they felt better if the lesion was invisible).Reassurance that the burn would not likely leave significant scarring and a quick lesson on management (immersion in cold water) of burns relieved any residual anxiety. \ I would hope that more first aid care (and how long to wait after injury) might be taught in schools.Dr. Robert Dickson is a family physician in Hamilton. This report is based on a real case from Dr. Dickson’s files.

Case report: Wait times

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