Post holiday downtime, hightime for the gout!

At the start of each year,  I would expect gout arthritis patients, old and new, to rise like unwelcome spectre of the most painful of bodily retorts to dietary excesses, and come limping to the clinic. This would be followed by a week or maybe a month -long of resolve never ever to taste alcohol or the beans! This first week of 2012, one call from a patient (a doctor) came and then the week pulled off with several consults of gout patients without the gout attack and reporting a happy new year indeed!

I would like to think that after 2 decades of rheumatology practice, the returns of doing customized patient education during the clinic encounter is finally reaping some returns. However, gout patients being in so much pain with each attack, may have visited another rheumatologist, self-medicated with their favorite NSAIDs, visited the emergency room of some hospital where steroids may have doused the fire, or took steroids by themselves, or as advised by a well-meaning neighbor.

By customized patient education, I mean  giving a set or  combination of statements about the gout, its treatment and how to avoid it, as the case requires.

The first step, is to identify types of patients with gout:

(Look, these categories are not absolute or exclusive, nor are these the product of any indepth research, nor in any way intended to be derogatory. This list is anecdotal and culled from more than 20 years of observation. I suspect that these are actually patients' reactions to this severe malady, more than anything else)

1. humble and teachable (quite rare, the one with the best prognosis)
2. wife/ mother dependent
3. officemate/neighbor dependent
4. pseudo-doctor
5. late disease (nodes and masses stud the elbows, knees, and feet, kidneys and intestines bad)
6. one- consult patient
7. the returning one- consult patient
8. confused

First visit: all patients receive the complete set of educational instructions  and memorize their medications, and no looking to the caregiver, please...

2nd to the 5th consultation and still with recurrent attacks:  patients slowly fall into any item in the above list, so instructions are delivered "differently" per category, emphasized, and patient is required to write instructions down.

5th visit onwards: not to lose hope, patient still comes back, so, reiterate important points, use the" I agree, but..." or, "you are doing excellently, but..." approach, let him write down and read back instructions in the clinic, recruit wife or family members to help remind patient...

The single call received this week, is a looking up for an optimistic 2012-  could the patients attending this clinic have licked the gout? I will have to wait though, for the rest of January 2012. I'm keeping my fingers crossed!