Today, we did home visits with patients in the community and I was able to have hands on experience in seeing patients with very advanced gout. The patient said that the doctor told her she had gout but she said she didn't. She also had obvious pitting edema from her congestive heart failure and hypertension yet she only takes her blood pressure meds "when she has symptoms" if she drinks too much water. I taught her to push into her leg to see when her leg was swollen due to leg edema as an indicator of her heart failure so that she can visually see when she has symptoms to remind her to take her medications. I also learned that she was taking simvastatin and that it's very common first line in Thailand because of the price compared to our first line of atorvastatin in the US. It's amazing that although we have evidence based guidelines for superior medications these patients still can not have access to the best available care. Another lady also had osteoporosis and I learned that first line calcium is recommended over a medication like alendronate because of the cost limitations as well.
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