The things I wonder...

[AngelfireRN]

1) If you have a primary doc, why don't you go to him/her? Why come here and expect to be fixed by someone who knows you not from Adam's housecat? I'm great if there's not an appointment available, or they're closed. But you just know that some are using the minute clinic as a candy shop, or don't want to be bothered with having to make an appointment.

Another thing in the same vein that I don't get...why, after, say, 3 rounds of abx for an upper respiratory complaint, is it considered an insult to advise someone to see their PMD?

Had that happen the other day. 3 rounds of abx in a month, no betterm chronic conditions that we knew little about. Suggested her PMD might be able to offer different tx that would be better for her. She got mad and left in a huff.

2) How can you not have a pediatrician for your child? That chaps my hide worse than any, I guess. A minute clinic is not a pedi office, yet you'd be amazed at how many people drag the kiddos in here, expecting immunizations, well-child care, etc.

Had one the other day that brought in a young teen, wanting the clinic to clear her for sports. New patient, no one had any history on her. The aunt brought in the physical form from the school, filled out front and back with all the child's health problems, including a rather severe heart condition. No cardiac follow up in 7+ years, no general medical exam in 4+ years. I flat-out refused to clear her, and I kept the clearance form with me, that woman was so squirrelly, I'd not have put it past her to forge a siggy. Called the PMD of record, they'd only ever seen her once. How can you consciously do that to a child with those problems?

3) Why does it always have to be our fault, when we've advised, treated, been ignored and then (GASP!) they don't get better? I know the answer to that, just frustrated, lol.

Feel free to add whatever confounds you.

[SHGR, MSN, RN, CNS]

Angelfire, I've read some of your other posts and know you love your job. Valid questions! Does your clinic have a written policy about some of those things?

The Walgreens clinic here advertises sports physicals for a very reasonable price. I think it's a great idea in general. But yeah, you could uncover a serious problem in a previously healthy kid too. I saw that happen once. I mean, that's the point of a physical, right?

But, to speak to your larger issues, people just don't know. It's not a character flaw. They just don't necessarily know stuff like what the ER is for (and huge billboards that say "Our doctors will see you NOW!" don't help).

[AngelfireRN, MSN, RN, APRN]

Suz, thank you for not jumping all over me. And there is no written policy, to answer your question. We're expected to see it all, even the active labor, though we have no DopTone or any means of assessing a fetus. They HAVE to have an exam, regardless if they're crowning or not.

In the course of a physical here, I have found serious stuff. That heart condition was a ticking time bomb. Random labs done on a vague complaint? Bingo, your liver's shot to heck.

CT to rule out a stone, hello, hydronephrosis. CXR to check a rib that the PMD didn't bother with? Lung nodules. Every day it's something. And these poor people are more than happy to follow up with someone who knows them. It's the ones that want a magic pill with no testing or effort involved that scare me.

[Nurse SMS, MSN, RN]

My Mom was talking to me the other day and revealed she has been using a Minute Clinic type of setting for a lot of her healthcare needs, even though she has a PCP who she really likes. I asked her why she was seeing the Minute Clinic instead of her doctor and she said it was so she would not bug her doctor so much....?!?! :baffled:

I explained to her she'd be better off if her doctor is in on all her medication refills and health scenarios and to use him/her unless it is impossible to get in. She was honestly shocked it mattered and had not given one thought to the importance of having a complete medical record in one place.

Truly, I think people are just clueless a lot of the time. The convenience wins out.

[leslie :-D]

Are all your clientele bothersome to you?

what's up with the snark?

And, while I do understand that the reasons listed are valid...there's just no excuse not to have care, continuous care, for your child.

i guess my question is, what makes you think that these folks have pcp's?

as you have already observed and noted, some of these folks have pretty remarkable med'l hxs...

that have remained unattended.

lots from the lower socioeconomic classes, are their own worst enemies.

they neglect themselves, and/or, they seriously have some worrisome knowledge deficits when it comes to their own healthcare.

and for those who do have a pcp, i wouldn't be a bit surprised to learn they are pushed to the end of the line...

just because they have medicaid or are slow to pay.

i'm sure the minute clinics seem like a quick, convenient, and attractive remedy.

i definitely hear you about the kiddos, though.

i seriously don't know how i'd handle a child's health being grossly neglected.

yes, clueless it is (but knowledge deficit sounds a whole lot more tactful.)

leslie

[zorabanks]

Well, I have had to go a min clinic more than once because can not get in to see my PCP without a month's notice. She has tooooo many pts. Last year I called to make an appointment with my PCP for ABD pain, accepted an appointment for 3 weeks from the time I called, about a week or so later saw blood in my stool, went ahead to ER, was admitted that night for GI Bleed, almost coded, and ended up in ICU for 2 days.

[AngelfireRN, MSN, RN, APRN]

what's up with the snark?

I know, right?

i guess my question is, what makes you think that these folks have pcp's?

as you have already observed and noted, some of these folks have pretty remarkable med'l hxs...

that have remained unattended.

lots from the lower socioeconomic classes, are their own worst enemies.

they neglect themselves, and/or, they seriously have some worrisome knowledge deficits when it comes to their own healthcare.

and for those who do have a pcp, i wouldn't be a bit surprised to learn they are pushed to the end of the line...

just because they have medicaid or are slow to pay.

i'm sure the minute clinics seem like a quick, convenient, and attractive remedy.

i definitely hear you about the kiddos, though.

i seriously don't know how i'd handle a child's health being grossly neglected.

yes, clueless it is (but knowledge deficit sounds a whole lot more tactful.)

leslie

Leslie,

part of our triage is to ask if they have a PMD. It's listed in the chart. We know that they have one, and that is part of my point. We also charge up front for services rendered, so there's no real way around that part. You don't pay, you don't get seen. I agree with you about the own worst enemy.

I guess it's just that I want to give the best care that I can, but I'm working at a deficit. And for a perfectionist like me, that gripes.

The kiddo thing makes me mad, though. Few things make me truly mad, but that does. I'm talking no immunizations, no well-child care, nada.

[nursel56]

Some really harsh commentary here!

I often use a "doc in the box" center for things like earaches, colds, etc. I've never been to one of the "Minute Clinics" associated with my local CVS pharmacy.

I've called ahead on a couple of occasions to see if what I wanted to be seen for was appropriate, and this particular place likes to do pre-employment and sports physicals through the Urgent Care side (they have a regular appt FP side as well) but to expect you to sign off on a sport PE with a 7 year hx of cardiac problems? My daughter has exercise-induced asthma and her school insisted she see an allergy specialist before they would give the OK for her to be on the cross-country team.

They are also very nice about giving a discount to cash customers and not charging for every little extra as is the trend nowadays. I always double check as I was once charged $70 to blow into a really cheesy peak flow meter. I would've used the one in my purse if I'd known they were going to do that.

I understand - I worked in clinics for many years. The only ones I felt totally crappy about were the MIs who really should have called 911 instead of trying to drive themselves in :-(

[AngelfireRN, MSN, RN, APRN]

Well, I have had to go a min clinic more than once because can not get in to see my PCP without a month's notice. She has tooooo many pts. Last year I called to make an appointment with my PCP for ABD pain, accepted an appointment for 3 weeks from the time I called, about a week or so later saw blood in my stool, went ahead to ER, was admitted that night for GI Bleed, almost coded, and ended up in ICU for 2 days.

This is not the point of my post. You DID make an effort to be seen, you didn't just up and decide that you were going to use "Doc In The Box, LLC" as your primary care provider. But, whereas you tried and could not get in, the people I have reference to don't. They either just don't and admit they don't, or lie and say they tried.

I've seen the same phenomenon mentioned on the ER boards, appt made, tired of waiting, so in they come. I thought maybe there was an insight that I was just not seeing (other than the aforementioned 'cluelessness'). I guess my main question, aside from why one does not try to see their primary...the woman who had a conniption when I told her to FOLLOW up with her PMD if the 3rd round of abx didn't help. I wasn't sending her out without treatment, but I also thought that, after that many meds, CXR (negative), and no improvement, she really needed to get his input.

Gi bleeds are no fun. I hope you're doing better now. I had to have a transfusion once because of one of those. No fun at all.

[AngelfireRN, MSN, RN, APRN]

Some really harsh commentary here!

I often use a "doc in the box" center for things like earaches, colds, etc. I've never been to one of the "Minute Clinics" associated with my local CVS pharmacy.

I've called ahead on a couple of occasions to see if what I wanted to be seen for was appropriate, and this particular place likes to do pre-employment and sports physicals through the Urgent Care side (they have a regular appt FP side as well) but to expect you to sign off on a sport PE with a 7 year hx of cardiac problems? My daughter has exercise-induced asthma and her school insisted she see an allergy specialist before they would give the OK for her to be on the cross-country team.

They are also very nice about giving a discount to cash customers and not charging for every little extra as is the trend nowadays. I always double check as I was once charged $70 to blow into a really cheesy peak flow meter. I would've used the one in my purse if I'd known they were going to do that.

I understand - I worked in clinics for many years. The only ones I felt totally crappy about were the MIs who really should have called 911 instead of trying to drive themselves in :-(

I see those every day, and think they're totally appropriate for a minute clinic. I did 15 sport physicals today alone. We're fast with those, and for a healthy child, no problem to get signed off. I insisted that that child with the heart condition be cleared by her PMD and a cardiologist, refused to clear her, and called to set up an appt with the PMD for her.

He was so enraged that the guardian tried to circumvent proper (and just DECENT) protocol, he refused to take the appointment from me, he insisted on speaking to her. She showed back up today, and said that he said the child could participate. I still refused to sign. I gave her the paperwork that I had kept and told her that, since the clearance came from him, he had to be the one to sign off.

I get you, too. Some people treat us like we're just as good as the ER, like the blue lady I turfed last week. Literally blue. No air moving, stridor, BAD shape. She got admitted and stayed for a week. From the time I hit her door, in 7 minutes, I had a line in, O2 on, btx going, and a bus there. She could have DIED!

But yet, I'm the one who's awful because I want to understand this thought process. Go figure.

Thank you for your kind words.

[GitanoRN, BSN, MSN, RN]

Unquestionably, is a matter of convenience & lack insurance, and maybe no legal papers, whatever the case I recalled working in a clinic as the one you have mentioned, and we made them feel welcomed. In addition, I do understand your frustration, regarding the issues you have stated. However, one must understand that our jobs can be a bit overwhelming at times. Having said that, we must remember that is because of these patients we are not on the unemployment line. Wishing you the very best on all of your future endeavors~

[PinkRocksLikeMe]

I am not questioning the fact that some problems do NOT need to be treated at a "minute clinic" I don't think the OP was saying no one should come to the clinic, if so she would not have a job. I do not see the problem though with a sports physical. My daughter got hers at one for cheerleading because her pedi (yes she still goes to one) they were booked over a month out and I knew she was up to date on everything and I had no concerns or issues to discuss. If a child is in school they are up to date on shots for the most part ( I leave that open because some people determine when you say that you mean 100% of every single person and every single situation) when the school year starts you have to show proof of this and most have all done and won't be due for more until college time (when referencing high schoolers) unless that have to have a booster, tetorifice, etc...

[lrobinson5]

Leslie,

part of our triage is to ask if they have a PMD. It's listed in the chart.

My pediatrician was my Primary care doctor until I was 22. The last time I had health insurance before that was when I was still seeing the pediatrician. I know that probably doesn't happen much, but I definitely had no access to care, but everyone read on my chart that Dr. X was still in charge.