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?