I think that the symptoms determine what tests to run of course. You are asking me ridiculous questions now. Should every person suffering arthritis take those tests every year? That is a ridiculous question.

/edit/
Perhaps I should be more explicit. ;) CT has *not* been considered useful for diagnosis of gout. There is a new dual-energy Siemens unit that is changing this but the "within 2 hours" boast means it is far more likely that the physician ordered a blunderbuss of tests, one of which pointed to gout. The UK physician also may have known it is gout, especially if she was attending monthly with other medical conditions, but saw no reason to CT it. ;-) As for treatment: you're right, we don't know what he prescribed but unless I'm mistaken, Tylenol would be called Paracetamol in the UK and if she is on that for a chronic arthritis then something else is going on. IOW I don't believe this is a case of "After months of non-attention in UK system, patient comes to cottage hospital in US and 2 hours later has had huge numbers of investigations meaning she received better care."

If someone shows up with a very swollen arm and severe pain though then it is realistic if all other possibilities have been ruled out. How do we know it wasn't a simple arthrocentesis test? How do we know her arm wasn't swollen until it looked like a balloon (some gout does that, but then as a doctor, you know that)?

Because that would ruin the story this author wanted to convey... if it was an acute event then that's different from the story of monthly visits to a UK GP who did nothing. Something has changed that needed investigation. It is true that CT probably wouldn't be the first box ticked in the UK but then we shouldn't assume that the New Hampshire physician had access to a DECT machine either.

Seems more likely to me that this is another of those "Europeans can't afford clothes" stories- old ladies are wandering around in England with untreated arms swollen up like balloons, gnashing their English teeth at passers-by, dressed in rags sent by US charities and refused treatment by a phalanx of Ayn-Randian NHS bureaucrats who rule over physicians laboring in Dickensian conditions. ;-)