My Questions for Urgent Care Clinics

27 Jan

I see a strong trend towards my families moving towards using walk-in/urgent/retail care clinics for their ill care.  We do our best to keep ill visits open for the same day although this time of year it does get a little more difficult given the overwhelming demand.  

So, I can’t say that I completely blame our patients when they do use the urgent care facilities but it still eats at me, especially when they use them during our normal business hours assuming they’ll get in and out “faster.”  We don’t have evening hours at this point so I can’t really blame my patients for using the clinics in the evenings.  I really feel that most of these visits could wait till the next day but I also understand that this isn’t necessarily keeping up with what the market desires at this point.

However, I do have a few questions that I think need to be answered by the walk-in care clinics so that patients still get good care.  We have a few practitioners in our town who do a great job and I feel our patients receive good care but issues still present themselves:

What do we do about continuity/communication?

I commonly have this conversation in my office…

Me: Well, he’s got an ear infection and since he hasn’t been on antibiotics for a year (judging by his medical record), I would recommend that we use amoxicillin.

Mom: Yeah, except he was on amoxicillin last month for an upper respiratory infection and then they changed him to some other antibiotic cause he wasn’t getting better, I think it started with a C or maybe it was a K.  I think it was either once or twice a day.  I’m not really sure.

Me: That’s ok…I have 30 minutes for you to wait in my room while I try to get those records faxed over to see what the heck is going on (sarcasm of course, and not really said)

I’ve thought about the ways I would like for this to go down better.  The only way I can figure it out is to have notes faxed to the PCPs for everyone that is in the walk-in clinic the morning after.  I think if I were designing a clinic that is how I would do it.  In the age of EMRs I don’t think that would be too difficult.  If you are a walk-in clinic that does this or somehow communicates with PCPs I commend you because when I need the records and they aren’t there it is difficulty.

What do you do about your incentives?

The incentives for providing care in a walk-in clinic are very different than what I see as my incentives.  I have a relationship with my patients such that I don’t feel pressure to do what they are asking of me.  I’ve never worked in one before but I would imagine there is a huge motivation to do what the patient is asking because you need to motivate them to come back to you.  I would hope that good doctors/NP/PAs would be staffing these clinics such that this would not be a big issue but I do commonly see things that make me wonder: antibiotics for UTIs with normal U/As, antibiotics for “strep throat” with a negative screen and a cbc, u/a, rsv, flu screen done on a 12 year old with fever to 103, body aches and an exposure history for flu in the past week…

Again for those of you out there doing this right….ignore me.  But I can’ imagine what it’s like to be trying to please people who are walking in and end up not needing any specific treatment.  I would love to hear from some who have worked in an urgent care clinic for their thoughts on this.

What do you do when you can’t provide definitive care?

 I got a phone call this week on about a child who was in a walk-in care clinic with strep throat and severe dehydration.  Fortunately, I knew the NP well who was calling me and we were able to work it out so that they patient could swing by my office on their way up to the pediatric floor for admission.  Also fortunately, the family was very nice and understanding.  But, can you imagine if they hadn’t been?  Here they have waited 3 hours (per the mom) at the urgent care clinic to then be told that they could provide the care that they needed and they were going to have to go wait again in the pediatrician’s office to be seen prior to getting any definitive treatment…My understanding is that commonly in the evenings, our local walk-in clinics send patients to the ER when they cannot provide the care that is needed.  Maybe this isn’t true, I hope it isn’t.  I would propose that it would be better for the walk-in clinics to have some arrangement whereby they can arrange for admissions with providers etc when they feel it is necessary rather than have the family start over again.  Or, if the patient has a PCP that they would call them to discuss the case with them.

Again, these are just some thoughts I had about urgent care and the issues I see beginning to present themselves.  I don’t see this as a trend that is going to come and go so i’m hoping that I can find a better way to interact with our urgent care clinics in a way that benefits my patients in the end.  Any thoughts would be appreciated?

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8 Responses to “My Questions for Urgent Care Clinics”

  1. Alison south January 27, 2013 at 9:45 am #

    I’ve never used a walk in clinic for my children and I don’t plan on ever using one, unless completely necessary! I do have relatives in larger towns who use them regularly for their children. They only use ther pediatrician for well visits! I’ve always wondered how that loss of communication played a part in the child’s health! I think your completely right on the fact that YOu, as my child’s physician, should know when they have used an antibiotic or how often they have ear infection! I do have an example that might have you understand why some do go to walk in clinics. My children, for some reason, ALWAYS get sick on the weekends 🙂 If the fever is bad enough I will call the on call doc to see if we can come in… Normally we get to! However, the last time my baby was sick I called during clinic hours on a Saturday ! I knew she had an ear infection because of the signs she was showing and the fever! However, the nurse that we had to talk to would not let us be seen because sHe said it was just a cold! So, probably if I was extremely worried I would have gone to a walk in! However, I just waited until Monday, came to see you, and got an antibiotic for an ear infection! I’m not knocking the clinic at all for not seeing us on that Saturday, but it was frustrating at the time! I knew she needed an antibiotic, but just had to endure 2 more long nights without it! I would feel very uncomfortable using a walk in clinic with my children. I don’t mind having to see another doc at pediatrics, but I always prefer you if that is a choice! So maybe it’s the hours that lead most to walk in clinics????

  2. Terry Johnson January 27, 2013 at 10:02 pm #

    Unfortunately, the “see, I knew he/she had an ear infection” after being sick for just a few days and the urgent care clinic diagnosis “confirms” the families concerns plays into them more likely giving the family what they want or have already decided is the diagnosis rather than providing good care. There was an interesting study performed in the late 80’s and published in the journal Pediatrics where they took normal healthy children with photographically-documented normal eardrums and had their parents take them into Urgent Care Clinics, ERs, etc. with the history of “fussy, pulling on the ear, night-waking, etc.” An incredible 25% of the time the doctor diagnosed an ear infection and prescribed antibiotics. Not really news to those of us who have had many visits for follow-up 1-2 days after a child has been seen in one of these facilities, diagnosed with ear infection, prescribed antibiotics and we visualize perfectly normal eardrums. The real dilemma for the primary care provider occurs when the frequency of ear infections can determine referral to ENT for tubes. How can some of these diagnoses be trusted? Every time you see the child they have normal ear drums, every time they are seen after hours/weekends, they have an ear infection?
    Frustration ensues for everyone involved. Parents who want their children to be cured. Providers trying to provide good, consistent care.

    • jrsmith120880 January 27, 2013 at 10:13 pm #

      Sounds like you’ve thought pretty deeply about this issue before as well…

    • jrsmith120880 January 27, 2013 at 10:28 pm #

      We occasionally get phone calls asking for referrals to ENT for patients we haven’t seen for months based on the recommendation of the walk-in clinic or ER doctor.

  3. Amanda January 28, 2013 at 5:58 am #

    Very interesting to hear about walk in clinics from a doctor’s perspective. I personally have only had 1 good walk in clinic experience, and that was at a CareNow facility in Ft Worth. It never occurred to me to have my records from a walk in clinic sent to my PCP. The main thing I took from this post is that I need to have Jude’s Cook Children’s records sent to your office! I sent them to Dr Walker’s office, but forgot to send them to you!

  4. Janice Hill March 30, 2013 at 1:19 pm #

    Maybe in the future a group of Pediatrician doctor offices be associated with their own walk-in clinic. The clinic be opened from 7PM to 6 AM. The pediatricians employ a Dr/PA for walk-in clinic position only. The information regarding the patient can be immediately faxed to the patient’s pediatrician so that visit is recorded on the child’s records. The walk-in clinic accepts only the patients for that group of doctors. Just a thought. Might save an ER visit, nervous mother, hours of loss sleep for patient and parent, relief for child, etc.

  5. Amanda Chatelain July 10, 2013 at 3:28 pm #

    I have not worked in a walk in clinic personally but my PCP Dr Cooksey has his own walk in clinic Afford-a-care associated with his office. On weekends or when I can’t be seen in his office I can go there and pay the same copay for going to my PCP cause its an automatic referral. Also he has access to my records from the clinic. I know in bigger cities there are pediatric walk in clinics. It would be a great investment for someone to open one here especially associated with one of the pediatric groups. 🙂

Trackbacks/Pingbacks

  1. What to look for in a pediatrician… | Doc J Smitty's Wife - September 9, 2013

    […] school ill, or will they send you to a walk-in clinic? {For more info on that, see Justin’s post here.} We’ve all had kids wake up sick, we’ve all had a kid come or be sent home from school sick […]

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