By Dr Umberto Russo (MBBS.FRACGP) and Dr Spiro Dukakis (MBBS. FRACGP)
On weeknights and weekends in the Greater Toronto Area, when Family Practices are closed, National Home Doctor Service doctors are on the road, treating patients at home for a myriad of acute, episodic illnesses. Illnesses that, while not life-threatening, require medical attention.
Between the two of us, we have more than forty years’ experience in after hours medicine, and from long practice we can tell you the ten most common reasons why people call National Home Doctor Service…
1. Acute respiratory infections
Unsurprisingly, especially in the winter months, respiratory infections are top of the list. The respiratory tract is particularly vulnerable to infection from viruses or bacteria, especially when it’s cold and people spend more time living in close proximity indoors.
Respiratory infections can broadly be classified as upper or lower. Upper respiratory tract infections include infections of the throat, tonsils, larynx and middle ear. Head colds, influenza and whooping cough also fall into this category.
Lower respiratory tract infections occur in the chest - either the trachea (windpipe) or lungs, such as bronchitis, bronchiolitis, croup and pneumonia. Influenza is a widespread infection which can affect the nose, throat and occasionally the lungs.
Symptoms for all these illnesses can be very similar: a runny nose, sore throat, coughing, sneezing, fever and headache. The doctor will assess the symptoms and may prescribe antibiotics if there is a bacterial infection present. Antibiotics, however, are no use against viruses. In many cases, a cold and flu medication, with rest and fluids, can help relieve symptoms.
Remember - frequent and thorough hand washing is the best way to limit the spread of infection.
Asthma sufferers have sensitive airways which react to triggers such as respiratory tract infections, cigarette smoking and allergies. The main symptoms are wheezing and coughing, and minor difficulty breathing. A feeling of tightness in the chest and shortness of breath can also be present.
If the after hours doctor diagnoses the flare-up as mild or moderate, a plan will be put in place to settle it. The doctor will try to identify and treat any trigger factors, add or adjust any medications and arrange further follow-up with the patient’s family doctor if needed.
However, when a patient’s symptoms are severe, including obvious difficulty breathing or gasping for breath, inability to speak a sentence in a full breath, or confusion or exhaustion, patients are advised to go straight to a hospital.
When severe asthma symptoms are evident, people should either call 911 or go straight to the hospital Emergency Department
3. Skin infections and rashes
Skin infections and rashes are very common. Many of these conditions, such as impetigo ("school sores") or staph infections can be treated by a patient’s family doctor. We also receive calls from patients who are suffering urticarial inflammations (or hives), usually caused by an allergic reaction. The inflammation looks like mosquito bites, ranging from the size of a pinhead to that of a dinner plate. The inflammation is triggered when the immune system releases histamine. Although they are often uncomfortable and sometimes painful, such rashes are not contagious.
Another common skin complaint is cellulitis, a bacterial infection of the skin that tends to occur on the lower legs and in areas that are damaged or inflamed. The bacteria enter broken or normal skin, and can spread easily to the tissue under the skin. The leg is usually red, swollen, warm and tender to touch in the affected area. Cellulitis can affect any age, but it is more common in older people. It is important to seek medical help for this condition and antibiotics are required to treat the infection.
4. Urinary Tract Infections
Urinary tract infections are very common, especially in women, babies and the elderly. Some of the symptoms include: wanting to urinate more often and urgently, if only a few drops; a burning pain when urinating; a feeling that the bladder is still full after urinating; pain above the pubic bone, or blood in the urine. It is important to seek medical help for this condition to prevent the spread of infection, and treatment with antibiotics may be needed. The after hours home doctor can usually provide some immediate relief for patients suffering from this painful complaint.
Gastroenteritis (or ‘gastro’) is an illness affecting the digestive tract. It is mainly caused by viruses, although it can also be caused by bacteria, parasites, toxins and other more uncommon causes. Symptoms include vomiting, diarrhea, nausea, stomach pains, fever, lack of appetite and generally feeling unwell (including tiredness and body aches).
The symptoms of gastroenteritis usually last 1-2 days, although sometimes they can last longer. The main complication of gastroenteritis is dehydration, so it is important for patients to keep up fluids, particularly little babies and young children.
Gastroenteritis is highly contagious, and can quickly spread around a childcare centre for example. Hygiene and handwashing are particularly important to prevent the spread of gastro illness to the whole family, and it is best to keep patients at home (away from school, work or childcare) while they are sick.
6. Eye complaints
Eye complaints are another very common acute medical condition seen by our doctors in the after hours. Acute eye complaints include red eyes, conjunctivitis and eye pain. Patients experiencing acute loss of vision are advised to go straight to a hospital.
Conjunctivitis is a contagious infection affecting the whites of the eyes, characterised by a yellow or green discharge, red congested eyes and stickiness to the eyelids. The causes are either viral, bacterial or allergy/pollen related. It can last from two days to two weeks. Children need to be kept home from school while the infection is active. Treatment is simple, with eye drops tailored to treat the infection and the symptom
Another common scenario is when somebody gets something stuck in their eye. A foreign object may enter the eye during dry, windy conditions, or perhaps during weekend outdoor activities such as gardening, DIY or sport. It may even involve an accident with saws, drills or lawnmowers. Patients naturally feel a sense of panic when they have something in their eye, so it is important to keep calm.
In superficial cases, the doctor can help by removing any foreign object found floating on the surface of the eye, or underneath the eyelid, with a cotton bud tip and a steady hand. For more serious cases, where a foreign object may be embedded in the cornea, the patient should attend the Emergency Department for removal under controlled conditions.
7. Sprains, strains, neck, back and hip pain
Musculoskeletal complaints are very common in urgent care medicine. Causes can range from acute sprains of joints and muscle areas due to sporting injuries or accidents, work-related strains to the back and neck, and ongoing neck or back pain due to long-term injury. Symptoms are usually swelling, pain, tenderness and heat from inflammation in joints or muscle groups.
A medical assessment is needed to exclude serious injury, illness or fractures. The doctor may recommend treatments such as simple analgesia, ice or heat and rest, and anti-inflammatory medications. In acute cases, the doctor may refer the patient to the Emergency Department for further assessment.
8. Elderly ailments
Many of our doctors see patients aged in their 70s, 80s and over, living either at home or in aged care facilities. Common ailments for this age group include injuries from falls, acute delirium, general illness deterioration, respiratory tract infections, gastro, pain from osteoarthritis, heat exhaustion, and other acute and chronic conditions.
When an older person needs urgent medical care in the after hours, often the first reaction of carers is to call an ambulance. That’s where a call to National Home Doctor can help. The home doctor can assess whether a referral to the Emergency department is warranted. And it is often in the patient’s best interest to be treated in situ, rather than go through the ordeal of a trip by ambulance to hospital. Our doctors work collaboratively with our elderly patients’ Family Doctor and other health care workers to ensure continuity of care with medications, treatment and follow up.
9. Migraine and acute headache
Migraines and headaches are common presentations in urgent medicine. ‘Headache’ covers any pain around the head, face or neck.
Headaches can be divided into two main categories: primary and secondary. Primary headaches are by far the most common, affecting most of the population at one time or another. They include tension headaches, migraine and cluster headaches, which can be caused by stress, anxiety, eye strain or squinting, poor posture or dehydration. Sometimes there is no obvious cause.
Secondary headaches have a separate cause, such as illnesses like sinusitis or influenza, hormones (particularly in women), head injury and concussion, or side effects of medications, alcohol, caffeine or tobacco.
Most headaches can be treated by rest, hydration and painkillers.
A very sudden onset of severe headache could be a sign of serious illness and needs urgent medical attention.
10. Ear Ache
Children are very prone to respiratory infections which may be complicated by acute otitis media (middle ear infection). This is particularly common in babies and children under five years old.
This illness usually presents at night time, with a child suffering severe earache and fever, and possible signs of an upper respiratory infection.
The home doctor will diagnose the problem and in severe cases provide treatment in the form of strong analgesia and antibiotics (if required). It is very important not to neglect treatment of otitis media to avoid damage to the ear drum.
After commencing treatment, the home doctor will generally recommend a follow-up appointment with the patient’s family doctor to assess the progress of the infection and to provide further treatment if needed.