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.

[merlee]

I have used the minute clinics for minor acute stuff when I couldn't get into my PCP - an eye infection, for instance.

But I have known other people who also think that since they can't always get a same day/next day appt with their PCP, that the clinic should be their main access.

I don't get it, either.

[MomRN0913]

Let me just ask, because I don't know so much about clinics. I know someone who doesn't have insurance or primary care provider. So she can't just walk into a doctors office. She doesn't have the money to pay for a doctors visit out of pocket, which is as we know very high price.

She went to a clinic when she was really sick, and all they gave her was amoxicillan. Well, she is still sick, I personally know what she needs but can't prescribe it, and she went back to the clinic saying the abc didn't work and they turned her away because the don't treat the same illness twice.

Pretty messed up. Now she can't get what she needs and we all know amoxicillan doesn't always work on the first round.

So now she is screwed.

She is a good woman, who works and divorced with a child. Her company doesn't offer health insurance, she can't find a job that does in these economic times, and she is rarely making it.

She wouldn't **** me off if she came into my clinic. My heart would go out to her, even if I didn't know her personally.

[rita359]

As far as being no excuse not to have continuous care for a child please realize you are coming from the perspective of a highly educated medical person. Many parents do not even have a high school diploma. Even some educated people aren't medically educated. Some people, even with insurance, have high deductibles and are barely making ends meet if they are making ends meet. Excuses, excuses, or just someone elses reality.

[CrunchRN, ADN, RN]

I did clinic for many many years and the inappropriate utilization and expectations from the public and other professionals (nursing homes etc) is just something that will never change. You just have to learn to roll with it.

I can remember nursing homes sending in 90 year old ladies with atrophy so bad there limbs had been twisted into pretzels for years and wanting us to do a pap smear for heavens sake. Sent in by ambulance on a stretcher.......... Uh,m sorry, not going to happen, if you cannot magically pry her legs apart how do you think we will and who in the world thought a pap smear in a demented old lady who cannot move was a good idea? Sigh.

I could go on and on.......

[SHGR, MSN, RN, CNS]

I want Michelle Obama to make a series of public service announcements (commercials) for the general public about when to go to your PCP (when you feel well if you have a chronic condition); when to go to the urgent care/minute clinic; when to go to the ER.

I think people would really listen to her. Usually, when someone is upset or in pain is not the time to try to explain this type of stuff.

[Altra, BSN, RN]

I totally hear you, Angelfire.

People treat the ER the same way, as a high tech McDonald's drive thru.

"I can get a CT scan here, right?" That was a question from a patient last week while I was triaging her for a complaint of intermittent headaches x months. It was accompanied by, "I have good insurance, so I don't need a referral from my PCP to see a specialist. But the neurologist gave me an appointment for next month."

While triaging, I explained that the PCP might not have been a bad idea anyway, to rule out myriad other causes of headaches -- a need for a glasses prescription change, some basic labs, a neck/disc problem, sleep dysfunction, etc. etc. And that a neurologist would probably want the same lengthy list ruled out before looking for a neurological cause. I got the *are you stupid* look. She just wants a CT scan right now to make sure she doesn't have an aneurysm.

Retail clinics are growing by leaps and bounds in my region's suburbia, and yes, people go there with active chest pain. Recently we got a transfer from one of these -- 50ish male, good primary care, several cardiac risk factors which he was well aware of ... he has an onset of crushing chest pain with diaphoresis, but has his wife drive him to the retail clinic. When he got to us, the MD actually asked him, "sir, did you think maybe it was your heart?" And the patient replied, "yes, but I was hoping they could take care of it there." 12 minutes later he was in the cath lab.

And I'm sorry, I don't see a pressing need for retail clinics to offer sports physicals for students. These are not a surprise. If your child plays a spring sport, physicals will be due by ________. If your child plays a fall sport, physicals will be due by ______. Life requires planning ... who knew??

[CoffeeRTC, BSN, RN]

I don't go to the doctors either clinic or my pcp

People want things done now or last minute so that is why the clinics are used more than the PCP (especially the really busy, overbooked offices)

Maybe they have a PCP that they go to but thier insurance expired. Are the walk in clinics cheaper?

Some people may feel like they are "bothering" the doctor.

These clinics are everywhere...maybe closer than the reg doc?

Doctor shopping??

As far as kids and insurance..I just looked into getting CHIP insurance for my kids when hubby quits or looses his job. Looking them over and even if we have to pay for it (for alot of people it would be free) it is sooooo much better than what we are paying a pretty penny for now thru hubby's work. The only thing with this is that you have to be without insurance for 6 months.

[AngelfireRN, MSN, RN, APRN]

Let me just ask, because I don't know so much about clinics. I know someone who doesn't have insurance or primary care provider. So she can't just walk into a doctors office. She doesn't have the money to pay for a doctors visit out of pocket, which is as we know very high price.

She went to a clinic when she was really sick, and all they gave her was amoxicillan. Well, she is still sick, I personally know what she needs but can't prescribe it, and she went back to the clinic saying the abc didn't work and they turned her away because the don't treat the same illness twice.

Pretty messed up. Now she can't get what she needs and we all know amoxicillan doesn't always work on the first round.

So now she is screwed.

She is a good woman, who works and divorced with a child. Her company doesn't offer health insurance, she can't find a job that does in these economic times, and she is rarely making it.

She wouldn't **** me off if she came into my clinic. My heart would go out to her, even if I didn't know her personally.

In the case of your friend, we would have no issue seeing her. Heck, we treat the same thing 2-3 times, or as many as it takes. But the difference is...she has no primary. The people I mentioned in my OP DO. They just choose not to go. I hope she gets better soon.

[rn/writer, RN]

We have excellent insurance through my husband's job. Even so, we just had a major change at the start of the year. The copay for a PMD visit and an urgent care clinic used to be the same. As of January 1st, the urgent care copay dropped to a minimal amount while the PMD copay rose. It's not horrendous, but it's a significant change. So, it isn't only the folks who have no insurance who might rely on a quick clinic. Even people with pretty good coverage are being "encouraged" to make that choice.

I also think that quick clinics are being used as a triage service by some. They don't know if what they have is serious enough to go through the lengthy wait times to see their PMD or sit for hours in the ED, so they turn to a place that they hope can help them get what they need without all the hassle. Doc-in-the-box clinics can also sometimes intercede (as someone mentioned above) to help a patient get an appointment sooner with the PMD or strongly urge them to get to the ED immediately, even calling 911 in truly life-threatening situations.

In this tight economy, there's a good percentage of the population that will go without medical care rather than take time off work to see a PMD. Being able to get in at 7:00 PM is a mighty attractive option for someone who doesn't want to jeopardize their job or lose half a day's pay.

Instead of being irritated or mystified by your patients who have a PMD and still choose to come to your clinic, why not just meet them where they are and give what you have to offer? For many, I'm sure it's not a choice between the PMD and the quick clinic. It's a choice between the quick clinic and no care at all until matters become urgent. People who used to go to the PMD for everything might now have outrageous deductibles and copays that, along with the lengthy wait times, make what used to be the default setting (when you're ill, go to your doctor) a decision that has to be considered very carefully weighed and considered.

Even if some patients are using your services inappropriately, you can choose to see your clinic as a gateway to the system and a touchstone for those who shun medical care for whatever reasons. At least they're starting somewhere. You have the opportunity to be an encourager or a scold. And this is true whether you ever say a word about your negative/puzzled feelings or not. Whether you are able to treat a paitient or you can facilitate a quicker PMD appointment or a much-needed trip to the ED for those your clinic truly cannot help, you've rendered a valuable service to those who put their trust in you.

[bernikitty]

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.

my son's ped refused to see my son after we lost our private insurance and i had to put my kids on medicaid. he had a fever and i suspect a sore throat (my son is autistic and non-verbal). the doctors' office told us that he was now considered a "new" patient and they were not taking any new patients (this doctor had been treating my sone for 3 years at that point). medicaid had assigned as my kid's doctor but the doctor refused to see him. when i contacted medicaid they referred me to a long list of providers in my area.

i quickly learned that the word "medicaid" is doctor repellant. when i beg them to give my son an appointment they told me to take him to the ER. medicaid told me that they would not pay for ER care unless it was life threatening.

all the while i was watching my son get sicker and sicker. finally on the morning of the third day i called the original dr's office and screamed at the nurse that i was bring him in and would not leave till he was seen. as i put my son in the car i was prepared to scream the doctors office down to get my son seen. i knew that i was more than willing to create a disturbance that might get me arrested.

i was living in a nightmare. at the doctor's office they found his o2 sat was well below 90% and the rales in my son's chest where long enough to hear with out a stethoscope. he has pneumonia and had to be admitted to the hospital where he had to endure IV placement (he ripped it out twice) and blood draws.

a quick exam and a script for an antibiotic could have saved my son so much suffering but we have a system that treats a poor sick child like a hot potato.

this was 2 years before i started nuring school but i will always strive to show pt more compassion and caring than what was shown to my son. you don't know what people's situations are. the last thing struggling parents need is your judgment. at that time if i had to "explain" the situation to the health care proffessionals i would have been a puddle on the floor.

a struggling parent seeking health care for their children is proof of concern and caring and they deserve the benefit of the doubt. you may find yourself one day in their shoes.

[AngelfireRN, MSN, RN, APRN]

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.

my son's ped refused to see my son after we lost our private insurance and i had to put my kids on medicaid. he had a fever and i suspect a sore throat (my son is autistic and non-verbal). the doctors' office told us that he was now considered a "new" patient and they were not taking any new patients (this doctor had been treating my sone for 3 years at that point). medicaid had assigned as my kid's doctor but the doctor refused to see him. when i contacted medicaid they referred me to a long list of providers in my area.

i quickly learned that the word "medicaid" is doctor repellant. when i beg them to give my son an appointment they told me to take him to the ER. medicaid told me that they would not pay for ER care unless it was life threatening.

all the while i was watching my son get sicker and sicker. finally on the morning of the third day i called the original dr's office and screamed at the nurse that i was bring him in and would not leave till he was seen. as i put my son in the car i was prepared to scream the doctors office down to get my son seen. i knew that i was more than willing to create a disturbance that might get me arrested.

i was living in a nightmare. at the doctor's office they found his o2 sat was well below 90% and the rales in my son's chest where long enough to hear with out a stethoscope. he has pneumonia and had to be admitted to the hospital where he had to endure IV placement (he ripped it out twice) and blood draws.

a quick exam and a script for an antibiotic could have saved my son so much suffering but we have a system that treats a poor sick child like a hot potato.

this was 2 years before i started nuring school but i will always strive to show pt more compassion and caring than what was shown to my son. you don't know what people's situations are. the last thing struggling parents need is your judgment. at that time if i had to "explain" the situation to the health care proffessionals i would have been a puddle on the floor.

a struggling parent seeking health care for their children is proof of concern and caring and they deserve the benefit of the doubt. you may find yourself one day in their shoes.

Your child had a legitimate condition that needed treatment. If you'll read what I've written, you'll see that I mentioned parents wanting immunizations for their children, as well as various and sundry things that a minute clinic is not capable of handling. It's not what we're set up for, and in some cases, it's something we can NOT do.

Acutely ill kiddos is a different ballgame. I'd never turn one away, and if there's a need for a PMD for a kiddo (or adult) I routinely offer to set them up with the primary clinic attached to the minute clinic. Payments are about the same, and we then have the capability of following them with a dedicated provider.

I never claimed to know what a situation is, but you can bet your sweet life that, when I made the decision to have my child, I made it with the intent to go without myself if it meant healthcare for him.

Your doc sounds like a piece of work. I can't say that, in your shoes, I would have done a single thing differently. But I will say, when I had one come in that has s/s very similar to what you describe, he was out the door to the ER immediately, simply because I (and the other NP) were afraid he was going to crump on us any minute. He was admitted as well. His idiot mother (sorry, no other word, she 'didn't think he was too sick') tried to talk me into just giving him a shot and letting them go home.

[Altra, BSN, RN]

I think it's worth mentioning, at this point, that as of (whatever the date was) the implementation of the first provisions of the Patient Protection & Affordable Care Act, insurance plans can no longer charge copays for annual well-child/well-adult exams, recommended vaccinations, and certain screening tests including annual Pap smears and mammograms. This probably accounts for the change in co-pay structure that rn/writer describes, as it has changed the revenue stream for office practices.

Before someone jumps on this -- YES -- I realize that this does not help those without insurance. But the OP is specifically talking about patients with established relationships with their PCPs.