Pain In the Toe!
I was having ongoing intense pain in the tip of my toe, nearby, but not at the nail. I thought it might be a piece of glass that I could not access, or perhaps another foreign body. I was unable to get a good look at it and a small spot at the tip of my toe was getting painful to touch. I went to my primary care doctor after my own day seeing patients. After waiting over 45 minutes for my appointment, my doctor walked in, looking dazed and overwhelmed. I was with her for exactly 4 minutes. She said hello, I showed her my toe, she said that’s an ingrown toenail, tore a prescription for an antibiotic off her prescription pad, scratched out the name of a local podiatrist and off she ran to her next patient, seemingly short of breath.
The experience resonated with a recent headline story on NPR, Good Medical Care Can Suffer Late In The Day. The author cited recent studies that reflect how medical care in general, and especially that related to preventive care recommendations, suffers as primary care doctors head into the later afternoon hours. Patients are less likely to receive preventive care reminders and if a patient presented with pain, they were more likely to leave with a prescription for opioids when seen toward the end of a provider’s work day. I would add, that because many primary care doctors run late, they can become rushed and harried.
Doctors are human and we all get tired. The current medical paradigm for primary care and the typical scheduling is not set up for physician health and now we learn, apparently not ideal for patient health either. Seeing patients every 10-20 minutes over an eight to ten or more hour work day is a set-up for problems to arise, for cutting corners and for less than optimal care. When you schedule your doctor appointments, aim for earlier in the day!
I was also reminded of a quote cited at the start of another journal article, The End of the 15–20 Minute Primary Care Visit:, “We can do it fast, we can do it well, we can do it cheap. Pick two.” I am not saying I needed a prolonged visit but the whole experience was not an endorsement for the current medical model. I was glad to know it was an uncomplicated, mild, ingrown nail, albeit an uncommon presentation. Beyond that, I felt entirely unseen, felt more like I’d taken a number at the bakery counter and had an impersonal and rushed experience with the person who is supposed to be following my overall health.
If she had taken time to recall my health history, she would know I was not a good candidate for a round of antibiotics. If she remembered my propensity for more gentle, natural approaches, she might have suggested a more conservative path. This was not a fulminating infection and there were no constitutional symptoms, though she did not take time to determine if that was the case.
Problems with Antibiotics
I did not want, or in fact need, an antibiotic. It is well-documented that the use and overuse of antibiotics is not good for individuals nor the public health. When essential, antibiotics are life-saving. But, If not an essential prescription, I would not want to interfere with my microbiome, so central to much of my immune system function and overall health. I would not want the common digestive, gynecologic or urinary tract side-effects of an antibiotic. I did not prefer a visit to a podiatrist who would take a small scalpel to my foot. But, because it was late in the day, because of how this office schedules patients, my doctor took the easiest and fastest course she knew and dispatched me in record time.
I have practiced naturopathic medicine for the past 34 years and like many licensed naturopathic doctors (ND), I created a practice where I have 90 minute first visits with patients and 30 minute follow-ups. I deeply value that time and how I can understand my patients and complex, often over-lapping medical complaints, contextualized within the rest of my patients’ lives, and in a calm and not hurried atmosphere.
Prevention is a cornerstone of naturopathic medicine, and when we look at the overall health of Americans, prevention should be a national priority. The facts are known that preventive care works. Being proactive with both primary prevention and early intervention helps patients sidestep the onset of disease, and keeps ailments from worsening, especially the big three, cardiovascular disease, diabetes and cancer. That said, the vast majority of current medical spending is on the treatment of disease, not on prevention. Preventive care takes time, the promise of whole-person primary care also takes time. Many licensed naturopathic doctors practice primary care and can help you with both preventive medicine and addressing symptoms and diagnoses you already have. With the growing shortage of primary care doctors across the country, naturopathic doctors can help fill that gap.
Treat that Toe
Back to the toe! Knowing what I was working with now, I went home, soaked my foot in hot water with Epsom salt, took medicines from my natural medicine toolkit (zinc, curcumin, probiotics,) and repeated the same the next morning. By afternoon, I had no further pain or redness, was able to trim the nail properly and was done with that small episode.
My recommendation to you: schedule your doctor visits for earlier in the day and find a licensed naturopathic doctor for your health care team!