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Saved by the Dr. Bell

"Why I Don’t Want You To Use Urgent Care/Walk-in Clinics"

In the last few years I have noticed Urgent Care Centers popping up in every town and city. These places are supposed to be an alternative to an Emergency Room visit: quick, easy and cheap (for the insurance companies). Insurance companies are promoting these places because an ER visit will cost 5 times more than an office visit, and if the insurance company can save thousands of dollars for one visit, they are all for it. It also is an alternative to a visit to our pediatric office because it offers “no waiting” and evening hours. Why wait 3 hours when your child can be seen now?

Unfortunately, in my experience with my patients, I have found that these Urgent Care centers are not what they are advertised to be, and are instead giving shoddy health care which, in the end, cause more problems then it helps.

Let me list my gripes:

  1. Misdiagnoses by non-pediatric doctors:

    These places are not staffed with pediatricians, but often are ER doctors with limited child experience. Sometimes nurse practitioners or physician assistants with little or no oversight of their work. I have seen in my office more than half of the “ear infections” to be false, pneumonias diagnosed as asthma or vice versa. They are ill qualified for pediatric work.

  2. Over-prescribed and inappropriately prescribed antibiotics:

    The joke in my office is that anytime a patient of mine went to an Urgent Care, I guess correctly that they got zithromax (azithromycin). It seems that every patient I see on follow up got this “wide spectrum” antibiotic. And, yes, there are situations to use this medication, it is inappropriate to use this “big guns” medication for ear infections and strep throat. (Hint: Penicillin/Amoxicillin is the first choice).

    Secondly on this point, every cold with sinus pressure is not a sinus infection, and every cold with ear pain is not an ear infection. Nasal mucus will fill the sinuses and middle ear space many times during a viral infection and cause pain. But a BACTERIAL infection, secondary to the viral infection of these areas take time, usually 5-7 days.

    Listen: sudden onset of ear pain in your child in the middle of the night at the beginning of a cold is usually just nasal mucus that dripped into the middle ear from the throat thru the eustachian tube. At-home management of this should be: sit up, take ibuprofen, drink water, take a steam shower, and maybe even Vicks. Zithromax at 3 am is not going to fix the problem or the pain.

    "Then why does the Urgent Care provider say my child has an ear infection and gives me a prescription?" Because you, the parent, want something done and immediate satisfaction is the goal of these clinics. Their goal is to have you walk out of their office happy, not appropriately treated. (Sorry, it's the truth).

  3. Over-prescribed oral steroids:

    This makes no sense to me. I have found that many of my patients received steroids for sore throats, cough, back pain, ear pain, and even headaches. This is criminal in my opinion. Steroids are very very serious medicine. (I’m not talking about anabolic steroids to increase testosterone levels, but corticosteroids that help with inflammation.) They should be used with the utmost caution. Your body makes natural steroids and maintains a small and consistent production by the adrenal glands. Doctors use steroids at 100 times the normal body level to suppress inflammation as it occurs in asthma and lung disease, or in severe allergic reactions such as from foods, drugs, or poison ivy contact. The dangers of steroids are many, including eye damage (cataracts), weight gain and obesity, hypertension, osteoporosis; and long-term use can damage any major organ in the body: liver, kidneys, heart or the brain.

    I find these days that almost every patient that visited an Urgent Care is getting a prescription for steroids for basic symptoms like sore throat and pain. Some of these patients are very young and do not need steroids. The vast majority of swelling and inflammation can be treated with over-the-counter medications like ibuprofen or acetaminophen.

  4. No follow-up or correspondence

    When we send a patient to a sub-specialist or to the Emergency Room, we expect a full report of what happened. When a patient gets treatment for a disease or injury, we as primary care physicians want to know what happened and what needs to happen next in our patient’s care. That’s our job.

    We do not have a partnership with the Urgent Care centers. They have no vested interest in following up with patient outcomes. When we call for reports or lab results, we are told its a HIPAA violation unless the patient has given written requests.

    They are not interested in communication with us because we are the competition for their patients. They are open during the same hours we are, and do not feel a relationship is necessary.

  5. Bogus diagnoses:

    I said it. I think some of the professionals that work at these Urgent Care clinics are lying about their diagnoses. I think they look in an ear and say “oh, an ear infection,” when the eardrum (tympanic membrane) is clear. I think they listen to the lungs and say, “oh, pneumonia” when they hear nothing. I think they do a rapid strep test on and have a negative result but tell the patient "it is positive for strep." I think they do a urine analysis test on a clean urine and say “oh, you have a urine infection."

Why do I think this?

Because I have seen it.

I have had patients follow up with me in less than 24 hrs of visiting these clinics and they have nothing wrong. Their repeat rapid and urine tests are negative. Their ear and lung exams are clear. I have had patients who had a mistrusting experience with the clinic and saw me the next morning without taking the prescribed medication and shown me this.

Why are they doing this?

Because, as I said, their goal is to provide satisfaction, not good patient care. They are interested in the bottom line and that is influenced by patients getting what they want. And what parents and patients want are not always what they need. Studies show patients feel satisfied when they walk out of a doctor’s office with a prescription for something. That’s why they went to the office, to get something to fix their problem. What they need, however, is a doctor to figure out if they have something dangerous, using their experience and knowledge, and providing proper treatment for infection, injuries and symptoms that does no harm.

"So," you are thinking, “What am I supposed to do?"

Well, at Fairview Pediatrics, we do have office hours from 8 am to 7 pm on most days. We have hours on Saturdays from 9 to 12. And we are soon to start beta testing walk-in hours from 8 to 9. We arrange our schedules to allow for parents and patients to call and get an appointment that day. Many adult providers and sub specialists make patients wait weeks to months before being seen.

“Well, what about after those hours?"

We have a nurse phone triage system that is there to help you decide one of three options:

  • Can it be treated at home,
  • can it wait until the next day,
  • or does it need to be seen right away at the emergency room?

This system has worked for many years, and it still is working.

The draw of an Urgent Care is that the service appears instantaneous. Quick in and out with a prescription for your suffering.

The truth of the matter is that the Urgent Care business is simply a business to give people what they want regardless of their actual health care needs. It might be more convenient to walk into these places without taking time from work or your busy schedule, but it is not quality care. We are invested in your long term health needs, whether you want to hear it or not! Please consider your health care carefully and call us when you need us. We are in it for the long haul.

Thanks,
Dr. Jamie Bell