Urgent care isn’t the answer to our broken system

By | November 8, 2018

I’ve only worked four shifts of urgent care so far, but four 12-hour shifts means I’ve seen a lot: a lot of patients, a lot of different ailments, a lot of different reasons that people come to urgent care centers.

I have to admit that this has been a breath of fresh air for me; compared to primary care, I work less frequently, I feel like the monetary compensation is fairer, and I work with support staff who have well-defined jobs, and truly support me.  We have true teamwork, and there is a sense of being in it together, whether we’re having a smooth day or one with more glitches.  I spend less time with the computer.  Charting is easier.  When I’m not at work, I’m not at work.  I don’t have an inbox to cover every day, and there is no “on call.”

I am learning new skills and relearning old ones.  I’m suturing — something I hadn’t done since residency — and taking care of sports injuries and concussions with a better knowledge base and with the equipment I need available to me.  I’m learning a little about pediatrics, too.  And I’ve had to refresh my skills on reading X-rays.  It’s all been kind of fun, really.

Do I miss my long-term relationships with patients?  Absolutely.  It’s what I miss most about practicing primary care, and I don’t think anything can take the place of those relationships.

But what I am finding in urgent care is important.  People come in needing the gentle touch and the compassion I aspire to provide just as much, if not more, than patients who have an ongoing relationship with the doctor they see.  Not everyone; some people come in for something minor and simple and they leave without thinking much about relationship, I’m sure.  But many people come in out of desperation.  They are sick or injured when they have no access to their doctor, and a wait in the ER could be hours, and they feel very vulnerable.  They have no idea who they are going to encounter, and what kind of care they are going to get.  If they have underlying anxiety or they are coming in with a sensitive issue, they may be particularly on edge.  A calming presence, a soft voice, a reassuring word to let them know that it’s going to be good care, and that I’m going to try to solve their problem, or at least relieve their distress, makes a huge difference.

Sometimes, patients land in urgent care because they have no doctor, or because they can’t get an appointment to see their doctor in a timely fashion.  Or they have gone to see the doctor and been dismissed, but still are suffering.  All of these are signs of the times:  we have a shortage of primary care physicians, access is difficult, and some docs are too burnt out to give the attention and reassurance that patients need.  If I can pick up that slack a little in urgent care, then I’m happy to do it.  I was one of those fried physicians who just couldn’t stay in the damaged primary care system anymore, but I still want to do my part to the extent I can.  I feel like I can do it by being a really good urgent care doctor — not by punting it all back, or by dismissing, but by being there when someone is falling through the cracks.

Another reason people end up in urgent care is because they may not be able to go to the doctor during normal work hours.  We can’t be primary care after hours, but we can make sure that someone gets the care needed for illness or injury when their doctor is not available.  And by making it a good experience, hopefully ensure that they’ll continue to seek medical care in general.

This isn’t the answer to our broken system.  I think people still need a relationship with a doctor who knows them in an ongoing, long-term relationship.  But until we can turn some of the trends in the system around and encourage doctors to do the work that we were intended to do with our patients, instead of being glorified data entry clerks and widgets, I’m going to stay over here, and hope I can do some good.

Rosalind Kaplan is an internal medicine physician who blogs at her self-titled site, Dr. Rosalind Kaplan

Image credit: Shutterstock.com


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