End of the Summer of Urgent Care

I could do as much as I’d dare

Sometimes not a moment to spare

From the first to the last,

It sure went by fast,

The summer I did Urgent Care.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa. This summer included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, a medical conference in Denver, and two weeks a month working Urgent Care in suburban Pennsylvania. Any patient information has been included with permission.

The vast majority of Family Practice involves delayed gratification or out-and-out frustration, the exceptional case, where the patient leaves better than when they walked in, comes as a treat.  When I owned my own private practice, I would have one or two a week.  Two would make a day, but a standard Urgent Care shift might include six.  Drain an abscess, stitch a laceration, remove a foreign body, clean out ear wax, splint a fracture, or take off a tick or any fraction thereof.

But I couldn’t give the anxious and depressed people my version of hit-and-run counselling.  Nor could I do much with the rather fascinating cases that required labs or sophisticated x-rays.  And if an x-ray showed a problem needing further imaging such as CT or MRI, I wouldn’t be part of the resolution.

I sent so many patients out by ambulance for chest pain that I can write about the aggregate without revealing any unique patient information, but I can say that people mainly concerned with chest pain shouldn’t come to Urgent Care.  I can say the same of the people who have the worst headache of their lives, severe abdominal pain, or anything problem related to pregnancy.  I won’t know what happened to those patients, nor the final diagnosis.

I saw very unusual x-rays and physical findings, but Urgent Care by its nature doesn’t involve follow-up, and I’ve resigned myself to not knowing.

When I took care of a person with a substance abuse problem, I had to make do with the briefest of interventions, but I suspect I did as much good, if not more, as I did in those cases where I had 45 minutes to spend.

I cared for 47 patients over the course of 12 hours my last day (this go round) in Urgent Care. I sent for the ambulance 3 times, I urged 4 more to the ER as soon as they could get there.  Out of 4 x-rays, 2 showed fractures.  For every patient for whom I prescribed antibiotics, I advised 4 that antibiotics would probably do more harm than good.  This late in the year I diagnosed poison ivy 4 times, with reactions much lighter than those I saw back in June.

I washed my hands or used alcohol based hand rub twice, minimum, for each of those patients, and I don’t anticipate the skin on my hands recovering for a week.

With that kind of patient flow I didn’t get a chance to talk to people about their lives.  I didn’t get to the fine points of social context leading to disease.  I missed quizzing people about the details of their occupations and hobbies, and learning about the wider world from the contact.

So I found the summer of Urgent Care gratifying but not satisfying.  Long, hot days have passed and the leaves are turning.  One morning I had to scrape frost from the windshield.  The action and immediate gratification might bring me back but for the time being I’ll work on something else.


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One Response to “End of the Summer of Urgent Care”

  1. Jonathan Taylor, DO Says:

    Nice touch on antibiotics, and telling them it would be more harm than good. I enjoy your turn of the phrase

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