Treatment protocols
Just as we have tried 'sentencing guidelines' to make
it less relevant which particular judge a defendant
gets there is a movement to make it less relevant
which particular doctor a patient sees and to have
treatment based on evidence rather than 'habits,
opinions that were handed down long ago, or other less
scientific practices'.
However, there are distinct delays in translating
research data into practice at the clinical level.
In my particular case, the doctor I saw was very young
and clearly this was his first case of gout. It may
also have been his first attempt to aspirate synovial
fluid from a toe. He did seek out the advice of his
attending physician, which was a good step for him to
have taken, but he was unable to aspirate any synovial
fluid and therefore less confident about dispensing
drugs for a condition that had not been confirmed by
the laboratory tests that would usually have been
ordered on the synovial fluid. He did diagnose my
condition as gout, but he obviously had to hit the
books before he was confident in prescribing
allopurinol. When a doctor 'hits the books' it usually
means something such as a "Five Minute Consult" or
other text that is reminiscent of a "Monarch Review
Notes" pamphlet. It hits the highlights, it does not
incorporate recent research, it does not incorporate
the views of any "different drummers".
Other countries do have different treatment protocols
and many studies on gout seem to be given short shrift
due to the small number of subjects involved.
I think it disgraceful that I was unable to get tested
for P. multocida which is thought by some to be a
cause of gout. It is transmitted by animal bites or
scratches and I had received a deep scratch about six
years ago. I do admit, however, that such a test is
not part of any treatment protocol or the
"conventional wisdom" about gout.