Health & Wellness

Seeking Advice and GP recommendation (ON)

  • Last Updated:
  • Dec 12th, 2019 3:19 pm
Member
Jul 1, 2008
259 posts
33 upvotes

Seeking Advice and GP recommendation (ON)

Hi there,

The wife has been dealing with extreme chronic pain in abdomen area for the past two months. Our experience with getting proper assistance from doctors around here (ON) has been so frustrating and stressful. Family doctor has been useless, just said take pain killers it will go away. After 2nd visit he finally referred for an ultrasound, which would have taken at least a week! Pain was getting worse (couldn't walk, sit or sleep), so we had to go to the ER twice to see an ER doc and get "quicker" referral for ultrasound and then a CT, waiting hours for both on two different days. The results came back "clean" as per the ER doctor, but the pain is still chronic, and they didn't have an answer either (except to prescribe painkillers which apparently is the answer to every problem).

I just feel like we are jumping around from doctor to hospital to clinic and nobody really takes the time to consider all the symptoms and advise. Now we are waiting for an MRI which was finally recommended as urgent after our THIRD visit to the hospital. The ER doctor who recommended it also said he would refer to a gynecologist but apparently seeing a specialist can take MONTHS. Also it didn't come as a surprise when the MRI department called and says the appointment is for FEBRUARY (apparently "urgent" doesn't mean much). Trying desperately now to find a quicker appt. Might try to go to an urgent care clinic to get referral for another location that's hopefully quicker.

Any advice would be appreciated. Maybe a good GP or clinic they can recommend that can see patients on short notice or offer 2nd opinion at least? And does anyone know how to get a quick referral for a specialist (in this case gynecologist)?
8 replies
Sr. Member
Dec 12, 2005
984 posts
398 upvotes
Richmond
Any other symptoms? Just pain in the abdomen?
Deal Fanatic
May 14, 2009
6759 posts
1499 upvotes
If you go to Buffalo, you could pay to have an MRI in a day or so. Just an option if you’re quite concerned about the wait time.
Deal Addict
Oct 3, 2013
2916 posts
4472 upvotes
West
What other symptoms/signs has she been having? Any fever? How about abnormalities to bowel/bladder function (i.e. visible blood/tarry stools, etc.). Did her family doc run a blood test? Urine sample? Stool sample? Any other tests?

I would consider asking your doctor to run the above if they haven't already; and if they refuse, just see another walk-in GP and ask.

I'm sympathetic to your frustrations, but unfortunately that is the medical system in Canada - it's pretty horrifying. Family doctors usually work off of statistics (i.e. 80% of back pain will go away in 4-6 weeks without any intervention), and the Canadian medical system trains them to just rely on those. That's why if you go to your doc, more often than not, they'll just shoo you away with Advil, and ask you to come back in increments of 2 weeks. There's simply a good chance whatever is happening will be resolved with just time alone. ER doctors are also only trained to deal with life/death scenarios. They're not much help for pretty much everything else.

As for imaging, there are 3 levels of urgency in the Canadian medical system with respect to images:

1) Immediate - scenarios where life/death is at stake; think car accident with a massive head injury. Timeframe is <24-72 hours.
2) Urgent - scenarios where new information could potentially have an impact on life, though not immediately threatening; think potential cancer. Timeframe is <1-3 months.
3) Routine - scenarios where neither of the above are applicable; think joint pain. Timeframe is <3-6 months.

Unfortunately, it really seems like they have graded your wife's case appropriately given the information you've disclosed. The CT & ultrasound is preferable to image the abdomen for 90+% of things; there are only a few cases where an MRI would be an upgrade.

Welcome to Canada, that's the cost of a public healthcare system - you have to wait your turn. Best you can probably do is try to get her on a cancellation list. If someone ends up being sick and can't make it, she'll have a chance of being bumped up. You are always free to get a private MRI, there are several places that will do so. Usually the cost is about $900-1000. I would consult your doctor first though (regardless of what you think of them), as if nothing was visualized on CT, chances are the MRI will show much of the same. They will also have to fax a referral over to the private clinic as well.
Member
Jul 1, 2008
259 posts
33 upvotes
Phonophoresis wrote: What other symptoms/signs has she been having? Any fever? How about abnormalities to bowel/bladder function (i.e. visible blood/tarry stools, etc.). Did her family doc run a blood test? Urine sample? Stool sample? Any other tests?

I would consider asking your doctor to run the above if they haven't already; and if they refuse, just see another walk-in GP and ask.

I'm sympathetic to your frustrations, but unfortunately that is the medical system in Canada - it's pretty horrifying. Family doctors usually work off of statistics (i.e. 80% of back pain will go away in 4-6 weeks without any intervention), and the Canadian medical system trains them to just rely on those. That's why if you go to your doc, more often than not, they'll just shoo you away with Advil, and ask you to come back in increments of 2 weeks. There's simply a good chance whatever is happening will be resolved with just time alone. ER doctors are also only trained to deal with life/death scenarios. They're not much help for pretty much everything else.

As for imaging, there are 3 levels of urgency in the Canadian medical system with respect to images:

1) Immediate - scenarios where life/death is at stake; think car accident with a massive head injury. Timeframe is <24-72 hours.
2) Urgent - scenarios where new information could potentially have an impact on life, though not immediately threatening; think potential cancer. Timeframe is <1-3 months.
3) Routine - scenarios where neither of the above are applicable; think joint pain. Timeframe is <3-6 months.

Unfortunately, it really seems like they have graded your wife's case appropriately given the information you've disclosed. The CT & ultrasound is preferable to image the abdomen for 90+% of things; there are only a few cases where an MRI would be an upgrade.

Welcome to Canada, that's the cost of a public healthcare system - you have to wait your turn. Best you can probably do is try to get her on a cancellation list. If someone ends up being sick and can't make it, she'll have a chance of being bumped up. You are always free to get a private MRI, there are several places that will do so. Usually the cost is about $900-1000. I would consult your doctor first though (regardless of what you think of them), as if nothing was visualized on CT, chances are the MRI will show much of the same. They will also have to fax a referral over to the private clinic as well.
Thank you for the information - are you by any chance a medical professional? You seem very knowledgeable on the subject.

The pain is lower right abdominal area and also has burning sensation. Other symptoms include low grade fever (~ 37.4), headaches and nausea. The ER ran the blood and urine tests but those were clear as well. They thought it was kidney stones at one point, but then ruled it out with the ultrasound. My wife also had a tumor removed from lower abdomen a few years ago. This is the reason we were very worried when this pain started. Also the reason I found it inexcusable of her family GP to not order any test (at least ultrasound) to begin with.

Unfortunately what you've said pretty much confirms my fears - if the doctors don't find signs of something sinister, they pretty much send you on your way, because they judge it not worth their time. It's extremely frustrating though as this completely affects her way of life - it's almost impossible to go to work in this state. Taking painkillers everyday is not normal either as it affects your stomach and can cause other issues. It's true that ultrasound and CT didn't reveal scary stuff, but as I've been told by doctors themselves not all tests are 100% accurate.

Update since my last post: we just heard back from gynecologist's office - 6 MONTHS wait. We are on the cancellation list but there are 30 people ahead. I find this absolutely ridiculous.

We are on the search for a good family GP so if anyone has recommendations it would be appreciated. It is tough to find, as a lot of them are not seeing any new patients. And any that are seeing patients won't do so until the new year.
Sr. Member
Dec 12, 2005
984 posts
398 upvotes
Richmond
If your wife had a tumor removed, can you get a referral back to that specialist? Most specially if the area of the current pain is the same? Have the doctors considered appendicitis?
Member
Jul 1, 2008
259 posts
33 upvotes
ai_c wrote: If your wife had a tumor removed, can you get a referral back to that specialist? Most specially if the area of the current pain is the same? Have the doctors considered appendicitis?
Unfortunately that specialist retired a couple years ago. Got referral originally to his replacement, but they wouldn't even see her as it was not deemed "urgent" enough. The only reason we even got the current specialist appt was that it came from the ER, and it is still a 6 month wait.

It seems like our health care system expects you to get seriously ill before they start taking care of you, instead of actually helping in preventing things from getting worse.
Sr. Member
Dec 12, 2005
984 posts
398 upvotes
Richmond
Sorry to hear that. I would just keep an eye on her symptoms and pain, if anything goes worse I would go back to the ER. Keep checking up on specialist see if any changes on the wait times. Good luck.
Newbie
Dec 22, 2008
66 posts
4 upvotes
GTA
magictrickx wrote: Thank you for the information - are you by any chance a medical professional? You seem very knowledgeable on the subject.

The pain is lower right abdominal area and also has burning sensation. Other symptoms include low grade fever (~ 37.4), headaches and nausea. The ER ran the blood and urine tests but those were clear as well. They thought it was kidney stones at one point, but then ruled it out with the ultrasound. My wife also had a tumor removed from lower abdomen a few years ago. This is the reason we were very worried when this pain started. Also the reason I found it inexcusable of her family GP to not order any test (at least ultrasound) to begin with.

Unfortunately what you've said pretty much confirms my fears - if the doctors don't find signs of something sinister, they pretty much send you on your way, because they judge it not worth their time. It's extremely frustrating though as this completely affects her way of life - it's almost impossible to go to work in this state. Taking painkillers everyday is not normal either as it affects your stomach and can cause other issues. It's true that ultrasound and CT didn't reveal scary stuff, but as I've been told by doctors themselves not all tests are 100% accurate.

Update since my last post: we just heard back from gynecologist's office - 6 MONTHS wait. We are on the cancellation list but there are 30 people ahead. I find this absolutely ridiculous.

We are on the search for a good family GP so if anyone has recommendations it would be appreciated. It is tough to find, as a lot of them are not seeing any new patients. And any that are seeing patients won't do so until the new year.
Which part of Ontario/GTA are you in?
Unfortunately evaluation and management of chronic pelvic/abdominal pain is difficult in situations where initial tests (blood, urine, ultrasound) are normal. Unless there is a focal finding (eg, mucopurulent cervical discharge, suspected pelvic mass), there is generally a limited role for ancillary laboratory or imaging tests. Exceptions include urinalysis to exclude urinary tract infection and microbiologic tests for sexually transmitted infections if patients are sexually active. Laparoscopy can be used for both diagnosis and treatment in women with some causes of CPP (eg, endometriosis, adhesions) but is also associated with surgical risks (eg, bleeding, infection, visceral organ injury). While performing laparoscopy on all women with CPP is unnecessary, underutilization can also result in a delay in diagnosis and appropriate treatment. The optimal timing for performing laparoscopy has not been determined and, if contemplated based on initial assessment, requires a discussion of the individual benefits and risks with the patient. The clinical features identified in the initial history, physical examination, and targeted testing guide the subsequent evaluation.

Here is a good general info link on pelvic pain:

https://www.merckmanuals.com/en-ca/home ... elvic-pain

PM me if you have any questions.

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