Thanks to laws that make it easy for them to operate, Texas has a burgeoning number of 24-hour clinics and free-standing ERs, two of which employ me (oh, fine, they contract with the doctor group that pays me, but the outcome is the same). Patients come in with minor injuries and with illnesses that got worse outside of office hours…but also with minor acute problems that could have been handled in their primary care doctor’s office.
My ERs are pretty low-volume (4-12 patients a shift), so I have the time to call the primary care doc and relate what happened if it’s important (I had to stop an ACE inhibitor due to the cough, that walking pneumonia in a 70-year-old needs to be seen again soon, etc.). Most patients seem to appreciate this, even if a few are a little miffed at being ratted out.
Having done primary care of outpatients for 15 years I understand what a pain in the schedule those walk-ins can be. And many primary care docs don’t realize that the receptionist has heard them complain about double booking enough that she just tells the patient to come in 24 hours from now–long enough to let a pyelonephritis worsen or gastroenteritis cause significant dehydration.
Larger doctor groups have a number of options: let one doc a day be the walk-in guy, set up a “service on demand” area in the same building, etc. etc. But is there any way for hard-working generalists to deal with the public’s increasing demand for no-waiting medical care? Comments, please!Tweet