Just Can't Wait




Now there's an alternative to ERs It probably happens to everyone at one point or another: You twist your ankle while doing yard work on a Saturday morning, or your child suddenly develops an intense ear ache after dinner on a Tuesday. With the doctor's office closed, and the typically long wait at the emergency room an unappealing option, what to do? Consider urgent care. Urgent care centers allow patients to arrive without an appointment when minor illness or injury strikes during hours when many primary care offices are closed, or when a patient simply can't get a timely appointment with a primary care physician. Understand your options Unlike hospital emergency departments, which remain the right choice for patients suffering from life-threatening conditions such as heart attack symptoms or severe bleeding, urgent care centers only serve patients with less serious health trouble. Urgent care is for patients whose minor cuts, sprains, coughs and the like require a doctor's attention but are not true emergencies. "Urgent care is very similar to an emergency department but with a little bit more of a limited scope [of practice]," says Garrett J. Bomba, M.D., Emergency Medicine Physician at Elliot Urgent Care in Londonderry. That limited scope means urgent care centers have less overhead and expensive back-up support than emergency rooms, enabling some patients who appropriately choose urgent care over the emergency room to benefit financially: most insurance companies only charge an office or clinic co-payment for an urgent care visit, rather than a more costly emergency-room fee. What to expect Many people who have experienced being an emergency room patient with a minor illness or injury groan about languishing for hours in the waiting area as more critically ill patients rightfully grab all the attention. In fact, in 2004, patients spent an average of more than three hours in the emergency department from arrival to discharge, according to the Centers for Disease Control and Prevention. "No matter how efficient an emergency department is, there will always be patients with higher acuity that bump people with lower acuity problems," says Melissa M. Wu, M.D., medical director of Immediate Care of Southern New Hampshire in Nashua. Urgent care is aimed precisely at those patients who would probably be placed at the back of an emergency room queue, Bomba says, which helps the centers get patients to an exam room more quickly. Patients are generally seen on a first come, first served basis and can expect to spend less time warming the seats in the waiting area than they would in an emergency room. In addition to minimizing waiting time, some urgent care centers strive to achieve a balance between creating an experience that mirrors what patients typically find in a regular practice, while still being ready for the unexpected since "We don't know what's coming in the door," Wu says. Urgent care patients, especially pint-sized ones, might find an urgent care center's atmosphere more pleasant and calm than that of an emergency room, because the loud noises and frightening scenes that can accompany more serious cases should not be present. Indeed, Wu says, many pediatric patients "love coming to see us." Urgent care centers enable non-emergency patients to immediately receive many of the services they need, with some centers offering x-rays and real-time readings by board-certified radiologists, Wu says. Many centers can also perform basic lab tests on-site. And although opponents of urgent care facilities sometimes voice concerns about patients walking in, receiving care and walking out, with no follow-up or communication with the patient's primary care physician, continuity of care need not be sacrificed, especially at the most wired urgent care centers. Electronic medical records allow urgent care centers to seamlessly link the care they give with doctors and hospitals, paving the way for appropriate follow-up, or urgent care centers will send primary care physicians a fax of the diagnosis and the care a patient received, Bomba says, including all lab work and diagnostic tests. Urgent care centers sometimes even provide a copy of patient x-rays on a CD for the patient to pass along to the primary care office, Wu says. The convenience of urgent care centers tempts some patients to end their relationship with their primary care physician and use urgent care as a substitute, but urgent care is meant to complement, not replace primary care, Wu says. "We do have some patients that say, 'Well, if I can get in here any time I want and I don't have to make an appointment and it's faster than the emergency room, why should I go back to my primary care physician?'" But, Wu says, "We always direct patients back to their primary care," or provide a list of physicians who are accepting new patients. Retail clinics Patients should be careful to note the differences between hospital-affiliated urgent care centers and in-store clinics that are found in drugstores or retailers, Bomba says. Retail health clinics tend to offer a more limited menu of services than urgent care centers and are not always associated with a larger healthcare facility, he says. The lines of distinction might blur, however, as in-store clinics evolve, Bomba says. "These retail clinics are learning that it is important to be associated with a healthcare system in the community," he says, so that patients are integrated into a system that will provide continuous, long-term care. Regardless, it seems likely that Granite Staters can expect more urgent care centers to pop up in the future. The schedules at many primary care offices are already so tight that it's sometimes difficult for doctors to squeeze in acute care or "sick" visits. As primary care physicians carry more patients and demand for medical access grows, Bomba says, the need for urgent care centers will intensify "until we come up with some sort of process that allows primary care physicians to see acutely ill patients in their offices again." NH

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