Urgent Care Centers - When should they be used?

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mr_scaramanga
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Urgent Care Centers - When should they be used?

Post by mr_scaramanga » Sun Mar 22, 2015 12:01 pm

A new 24 hour urgent care center just opened in our town. I have not had a need to visit it yet. I have been having trouble figuring out what services they provide and when they should be used.

If I had any condition that I felt required urgent care, I think I would almost always go to an ER. If I go to an urgent care center and they decide I need treatment they can't provide, then I've wasted precious time. It doesn't seem worth the risk.

I live a few miles from a large suburban hospital, and maybe 10 miles from a number of major urban hospitals.

The only benefit I see is that my insurance charges a co-pay of $100 for urgent care and $250 for ER.

Has anyone used these types of businesses? What were your experiences? Maybe some medical providers on this board might know more about them? Thanks
Last edited by mr_scaramanga on Sun Mar 22, 2015 1:04 pm, edited 1 time in total.

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Re: Urgent Care Centers - When should they be used?

Post by TexasPenny » Sun Mar 22, 2015 12:12 pm

I have used the urgent care around the corner from my house twice. Once was for a small cut on my finger that needed stitches. The other time I had food poisoning and kept throwing up. They gave me a shot that stopped the throwing up for awhile and then prescribed some pills that were supposed to help too. I think of urgent care places as useful if you can't get in to see your family practitioner, usually because of the time the illness/injury happens - early/late in the day or on a weekend. Ear infections, strep, pink eye, stitches for cuts, twisted ankle....stuff you don't think you need an ER for, but can't get in to see your family doctor.

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Re: Urgent Care Centers - When should they be used?

Post by Raladic » Sun Mar 22, 2015 12:14 pm

I've been there for an accute ear blockage on the weekend, since my family practitioner isn't open on the weekend.

sambb
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Re: Urgent Care Centers - When should they be used?

Post by sambb » Sun Mar 22, 2015 12:14 pm

urgent care = no specialists, no consultations, and no admissions generally speaking. Often limited radiology findings. they do good work though
good for sprains, sinus infections, minor bruises or scrapes, flu shots, routine blood work, insect bites, physicals, minor things that are not emergencies. Also, if primary care is out of town and you need something examined, etc.

Im sure the doctors will chime in..

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Re: Urgent Care Centers - When should they be used?

Post by cheese_breath » Sun Mar 22, 2015 12:20 pm

I find they're a handy substitute for my primary care doctor when he's so booked up with appointments that I'd have to wait a week to get in. If I have a flu or rash for example I can get a doctor to examine me and write the necessary prescriptions right away. The one's I've used do have diagnostic equipment such as x-rays, etc. But like OP, if I thought I needed that I'd just go directly to the ER.
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Re: Urgent Care Centers - When should they be used?

Post by Watty » Sun Mar 22, 2015 12:34 pm

Around here if you go to the emergency room with something that does not seem very serious then you can end up waiting hours to see someone. Being stuck in the ER waiting room with a lot of other sick people is a a good way to catch whatever they have, especially during the flu season.

I have seen Urgent Care centers that had a sign out front that gave the current waiting time to see a doctor(or PA I assume) and it was usually less than 15 minutes.

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Re: Urgent Care Centers - When should they be used?

Post by vitaflo » Sun Mar 22, 2015 12:37 pm

Where I live urgent care is about the only place to see a Dr in a timely manner. Almost all primary care dr's are booked out at least a week here, if not more. So if you have an ailment that can't wait a week to get diagnosed, urgent care is where you go.

As for when to go there and not ER? If you're not bleeding, broken, or have cause to think you're in imminent threat of dying, urgent care is probably the better (and cheaper) option. ER's should be for actual emergencies, not for the flu or strep or ear infections.

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Re: Urgent Care Centers - When should they be used?

Post by whaleknives » Sun Mar 22, 2015 12:38 pm

Your medical insurer probably has recommendations (or requirements) for you. Mine says
  • Emergency care is care for medical conditions that will likely result in serious jeopardy to a person’s
    health or that of an unborn child. Examples of conditions requiring emergency care include:
    choking; drug overdose; heart attack; seizures; stroke; and unconsciousness.
  • Urgent care is for conditions that require timely treatment when your primary care physician is not available. Call your doctor or NursePlus at 866-775-8776 if you’re not sure where to go. Do not go to a hospital ER for urgent care unless instructed to do so. Examples of conditions requiring urgent care include: minor broken bones; minor cuts; minor burns; drug reactions; non-severe bleeding; and sprains.
Is the urgent care clinic in your insurance network? You may or may not even have the option of using it.

Primary care clinics have been sending patients to urgent care and the ER for years, if a patient needs (or wants) to see a doctor and they have no schedule openings. Just realize that both urgent care and ER triage patients, and you might find yourself waiting behind more serious conditions.
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Re: Urgent Care Centers - When should they be used?

Post by poker27 » Sun Mar 22, 2015 12:52 pm

Even though I've only been to urgent care a few times (maybe only once cant even remember now), I'm a big fan. In Chicago, there must be 5-7 of them within a mile of me. If I suspected I had strep throat, it would take me 2-3 days to get into a 'real' doctor, or I can go same day to an urgent care place.

I was 98% sure I came down with gout, went to the place, got a x ray and blood work same day, and left with meds. Got the results few days later and was told to go see a dr. I'm one of those people that will sleep out the flu, or take pain killers for ear infections, just because of the hassle of setting up a real dr. appointment. Now I can walk into one of these places to make sure I'm not dying

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Re: Urgent Care Centers - When should they be used?

Post by Lon » Sun Mar 22, 2015 12:59 pm

We now have three choices when we need non life threatening medical assistance with the ER being the most expensive, Urgent Care second and On Line video assistance third. My supplemental Health Plan has just added Am Well On Line Video. Many minor medical situations that are handled by Emergency Rooms can be handled at Urgent Care facilities at considerably less cost and by AmWell On Line Video at even lesser cost. It's obvious which one the Insurance companies would prefer. The On Line Video you talk face to face with a specialist who can prescribe for you if needed, The cost for the consultation on line is $45.00. Am Well would have some of your medical history which you supply them when signing up for the service.

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Re: Urgent Care Centers - When should they be used?

Post by mikep » Sun Mar 22, 2015 2:47 pm

Depends what insurance plan you have, if they are covered and what the cost is vs your regular dr. with our HDHP plan our urgent care costs $70 for a visit and the primary Dr. costs $223. So I would prefer to go to urgent care all the time and skip the Dr. altogether except for annual physicals which costs $0. YMMV.

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Re: Urgent Care Centers - When should they be used?

Post by mhalley » Sun Mar 22, 2015 2:52 pm

The problem with urgent care centers is that unless your condition is super obvious they do not want to take any malpractice risk and will send you to the er for further evaluation. Any condition that could possibly be serious will result in an uc bill and an ER bill. SO if you have chest pain, shortness of breath, abdominal pain, any neurological symptoms (numbness, weakness, headache, etc), possible serious infection (High fever), or just a vague complaint will result in an ER referral.
Even many lacerations will be referred, even though the uc could have repaired them. I have seen many people in the ED where I thought the referral was uncalled for, but the uc referred them in order to "cya". Most of the the time this happened I would be able to care for the patient without too much more workup (ie expense to the patient) but if the uc sends you a patient to rule out appendicitis, even if the ER doc doesn't think it is appendicitis the patient will end up with the full work up (labs, urine, cat scan, etc).
Don't get me wrong, urgent cares are great and do an overall great job of seeing patients that would otherwise end up in the ER with the horrible wait and extensive workup that usually happens there. I think there needs to be a widespread push to train the general public in how to choose when to go to the ER, the UC or their family doctor.
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Re: Urgent Care Centers - When should they be used?

Post by mr_scaramanga » Sun Mar 22, 2015 3:21 pm

mhalley wrote:The problem with urgent care centers is that unless your condition is super obvious they do not want to take any malpractice risk and will send you to the er for further evaluation. Any condition that could possibly be serious will result in an uc bill and an ER bill. SO if you have chest pain, shortness of breath, abdominal pain, any neurological symptoms (numbness, weakness, headache, etc), possible serious infection (High fever), or just a vague complaint will result in an ER referral.
Even many lacerations will be referred, even though the uc could have repaired them. I have seen many people in the ED where I thought the referral was uncalled for, but the uc referred them in order to "cya". Most of the the time this happened I would be able to care for the patient without too much more workup (ie expense to the patient) but if the uc sends you a patient to rule out appendicitis, even if the ER doc doesn't think it is appendicitis the patient will end up with the full work up (labs, urine, cat scan, etc).
Don't get me wrong, urgent cares are great and do an overall great job of seeing patients that would otherwise end up in the ER with the horrible wait and extensive workup that usually happens there. I think there needs to be a widespread push to train the general public in how to choose when to go to the ER, the UC or their family doctor.
Mike
I agree there needs to be a push to educate the public about appropriate uses of UC.

I am quite confused myself. For example, I would have thought that a high fever might be appropriate condition for UC to treat. From your post, it seems like that they would probably refer that to the ER.

Do you know if UC are staffed by MD's or DO's? Could they have PA's or NP's seeing patients?

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Re: Urgent Care Centers - When should they be used?

Post by NaOH » Sun Mar 22, 2015 3:41 pm

mr_scaramanga wrote: Do you know if UC are staffed by MD's or DO's? Could they have PA's or NP's seeing patients?
My n=1 experience with urgent care was being seen by an APN, but it was a simple upper respiratory infection.
Judging from the scripts I see from local UCs, there is usually at least one MD/DO on site.
Of course, now there is the big push from CVS/Walgreens/Walmart/etc to get into the UC game, and they do tend to have only midlevels. Not sure how I feel about that, really.
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Re: Urgent Care Centers - When should they be used?

Post by prudent » Sun Mar 22, 2015 3:49 pm

The urgent care place near me is staffed by MDs. Have been there 3 times - to have something removed from my eye, to have a cyst drained after it started to bleed, and to see if I had broken my finger or if it was just a sprain. I was very pleased. I was seen in under a half-hour each time vs. what would have been hours in the ER. They prescribed an antibiotic for the cyst and they filled it right there (or I could have taken it with me to get filled - but it was late in the day and the pharmacies weren't still open).

I am going to urgent care as my first option when something needs attention today but not ER-level (chest pain, etc.). The ER at our closest hospital is always packed (I can see the waiting room whenever I visit someone in the hospital), and trying to get a same-day appointment at my doctor results in "come in and we'll squeeze you in" and I sit there for hour after hour.

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Re: Urgent Care Centers - When should they be used?

Post by mhalley » Sun Mar 22, 2015 3:51 pm

If there was a major flu epidemic going on, and you had the symptoms of the flu, then perhaps they would be able to diagnose and treat you for the flu. Also, if it is a child, often many children can have a high fever due to a virus, and if they look fine they could be treated as a viral syndrome. It all depends on the doc at the end of the day, and how comfortable they are with their diagnosis. Fever can be due to multiple serious illness, ranging from pneumonia to meningitis, in addition to the relatively benign viral illnesses.
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Re: Urgent Care Centers - When should they be used?

Post by mhalley » Sun Mar 22, 2015 3:55 pm

I have no problem with midlevel providers staffing urgent care centers. Most people will self select and not be that sick anyway. There is always the possibility of someone coming in complaining of elbow pain that is having a heart attack, or a sore throat that has epiglottitis. I worked with many PAs and NPs that I would put right up there with the ER docs in their diagnostic ability.
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Re: Urgent Care Centers - When should they be used?

Post by choices » Sun Mar 22, 2015 4:00 pm

Family has used them for tetanus shots, UTIs we have been well pleased with the service and wait times.

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Re: Urgent Care Centers - When should they be used?

Post by JPH » Sun Mar 22, 2015 4:08 pm

In my city we have both urgent care centers and free-standing emergency rooms. I stopped in at one of the ER centers near my home, and they told me they are considered a hospital. They do not accept Medicare. I asked my primary care physician about it, and she told me that some of them are affiliated with a particular hospital network, and that might not be obvious or volunteered. She said if you need to be transported to a hospital, you may not be asked which one you prefer. In this particular one, they have certified ER physicians and lots of diagnostic options. I'm leaning towards going there in a bona fide emergency.
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Re: Urgent Care Centers - When should they be used?

Post by HIinvestor » Sun Mar 22, 2015 4:10 pm

I went to an urgent care for the 1st time last month. It was the same one my friend had taken her D to when they were visiting HI months prior. I had a very painful and tender ankle that I had rolled and couldn't bear weight on. Her D had had an ankle they suspected may have been sprained and were able to get medical assistance confirming it was only a bad sprain not a fracture. They had gone to ER in a prior trip for my friend when she had fallen off a horse and waited many, many hours to be seen and didn't want to repeat that prolonged waiting experience.

I was the only patient there--they loaned D a wheelchair to help me reach their center, and I was promptly seen. First I had vital signs and history taken by someone. An ER doc saw me after that and took me to their imaging room for xrays which she read on the spot. She diagnosed a fractured fibula and then ushered me back to the original exam room. They discharged me with a LOW inflatable air boot and Rx for crutches, and recommended I follow up with an orthopedic surgeon. I got the Rx for crutches filled at Walgreen's. The next day (Saturday), I went to a walk-in orthopedic clinic, where the NP looked at the xrays I brought from the Urgent care clinic and gave me a new TALL boot, saying that the short one didn't provide enough stability & support for the fracture. They also gave me a referral to an orthopedic surgeon (associated with their clinic) at my request.

S also went to an urgent care after he was rear-ended on a business trip and it was near his hotel. He was having headaches. He was checked out briefly and found to be OK & advised to take NSAIDs.

My only issue with the Urgent Care Clinic is that they should NOT have dispensed the wrong boot, which I had to pay a co-pay for and my insurer had to pay for as well. They gave me the most detailed written instructions and information of any of the places I have seen. They also did not have crutches that fit my height, so I had to get them elsewhere. The other thing is that the company that they work with to dispense the boot is very over-priced. The boots sell for under $40 on Amazon.com. They billed over $500 and got insurer to pay over $250 and me to pay an additional $65+! Since I was in great pain, I am grateful they had the boot, but that seems an extravagant markup to me! They also said it was fine for me to take ibuprofen but the Ortho later said that it is better to stick with Tylenol, as there is some evidence that ibuprofen and other NSAIDs (excluding Tylenol) can interfere with bone healing.

In summary, I think Urgent Care CAN be useful, especially as they are open 7 days/week and can help with SIMPLE issues. They can get thrown with more complicated ones. A friend had Gillian barre (unbeknownst to him or the docs), but the Urgent Care insisted he had a cold and/or allergies. He was finally correctly diagnosed by his family physician (when he returned from vacation). Buyer beware about being discharged with inappropriate equipment. They tend to have a significantly shorter wait time than the ER, where you can be forced to wait for many, many others, some of whom use the ER for their routine medical care or when they run out of Rx meds.

In terms of reimbursement, check with your insurer. For my BCBS PPO plan, my co-pay was the same $15 I pay for any office visit, plus a small co-pay for the xray and another co-pay for the boot. I believe most Urgent Care places are participating and preferred with most insurers, but would call to check to avoid expensive surprises. It can be more convenient to snag an appointment at a place that is physically nearer than trying to be squeezed in to see your primary doc. If they have xray and boots and crutches, it can save you going all over to get diagnosed and treated. They can also be handy for a throat culture, antibiotics, allergy Rx, rash, sprains and simple fractures, as well as immunizations, fever, check ups, etc.

Minute Clinics in CVS have much more limited services and do not have xray machines on premises. They are staffed by NPs and not MDs. Some of the Urgent Care places in our state are staffed by medical assistants that do not seem to have much knowledge and I would never go to these places--they are mostly for work physicals & sports physicals, I believe.

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Re: Urgent Care Centers - When should they be used?

Post by roka » Sun Mar 22, 2015 4:20 pm

My wife and I use them for things like sinus infections where we're fairly confident what we have and just need a prescription. In and out in a matter of minutes rather than hours or even days trying to see a doctor.

I had occassion last year to use an UCC for what might have been something more serious. They were able to write the order for some imaging to see what was going on and review the results with me when they came back. They said they would have been able to refer me to a specialist if that had been necessary. In essence they were able to act as a primary care doctor since I didn't have one. The fees were low and their level of expertise and competence was good. I'd use them again without hesitation.

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Re: Urgent Care Centers - When should they be used?

Post by fsrph » Sun Mar 22, 2015 4:34 pm

mhalley wrote:The problem with urgent care centers is that unless your condition is super obvious they do not want to take any malpractice risk and will send you to the er for further evaluation. Any condition that could possibly be serious will result in an uc bill and an ER bill. SO if you have chest pain, shortness of breath, abdominal pain, any neurological symptoms (numbness, weakness, headache, etc), possible serious infection (High fever), or just a vague complaint will result in an ER referral.
Even many lacerations will be referred, even though the uc could have repaired them. I have seen many people in the ED where I thought the referral was uncalled for, but the uc referred them in order to "cya". Most of the the time this happened I would be able to care for the patient without too much more workup (ie expense to the patient) but if the uc sends you a patient to rule out appendicitis, even if the ER doc doesn't think it is appendicitis the patient will end up with the full work up (labs, urine, cat scan, etc).
Don't get me wrong, urgent cares are great and do an overall great job of seeing patients that would otherwise end up in the ER with the horrible wait and extensive workup that usually happens there. I think there needs to be a widespread push to train the general public in how to choose when to go to the ER, the UC or their family doctor.
Mike
mhalley gave you very good advice. Urgent care facilities should be used for minor problems, we all know that. ER should be used for serious ailments, we know that too. The problem is there are many gray areas. Dizziness, for example, could be from low blood sugar, low BP or middle ear problems. But it could also be a neurological (stroke) symptom. So where do you go in that case? I don't have the answer but hopefully a good Urgent care facility will send you to the ER asap if they can't handle the problem.

Francis
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Re: Urgent Care Centers - When should they be used?

Post by HIinvestor » Sun Mar 22, 2015 4:42 pm

Yes, it is prudent to keep in mind the patient's age, medical history, age, and suspected problem in choosing whether to go to UCC.

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Re: Urgent Care Centers - When should they be used?

Post by DRT » Sun Mar 22, 2015 4:42 pm

My local hospital operates an urgent care facility staffed by NPs. There's no charge if they refer you to the ER. The wait is usually not too bad, and they accept appointments (same day only). They've become my primary care option. I only use traditional primary care for ongoing issues.

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Re: Urgent Care Centers - When should they be used?

Post by tractorguy » Sun Mar 22, 2015 4:55 pm

I've used urgent care 2-3 times/year for the 5 years. I wouldn't consider an emergency room unless its possibly life threatening.

The one I go to in my area is part of the same conglomerate as my primary care physician and shares all records. I get seen by a doctor who is generally younger and a new hire in the conglomerate. I think its part of their training program for GP's. Generally, I've been in for eye infections, a cut that required a tetanus shot, and that type of thing.

I also went to an urgent care when I was on vacation 1000 miles from home and tore my achilles tendon. I did this on a Sunday and was vacationing at the Jersey shore. The urgent care doc diagnosed me, put my leg in a splint so I could hobble around, gave me crutches, and a prescription for a pain killer. He also gave me a referral to an orthopedic surgeon that I saw the next day. The surgeon probably cost my insurance 4x as much. All he did was give me a boot to immobilize the foot and spent 10 minutes telling me how good a surgeon he was. After I told him that surgery would have to wait until I got home after my daughter's wedding, he stopped talking and let me go.

My only bad experience with an urgent care was on another trip to my daughter's house in Maryland. I was bother by a cyst and decided I'd see one about it. The prescribed a sulfa drug for it. Turns out I had a rare but typical reaction to sulfa (fever and nauseau) that the urgent care didn't know could happen. They referred me to the emergency room. After spending a day in emergency and running every test under the sun, the emergency room doc finally told me that this probably was just a drug reaction and it would go away 24 hours after I stopped taking it. It was and it did. 5 years later, I still have the cyst and have added sulfas to the drugs on my don't take list.

Emergency rooms are expensive for hospitals to build and staff. They contain a lot of expensive equipment and staff and have to be sized to handle the worst case disaster. Anything that limits the load on these expensive facilities is IMOP a good thing in the fight to keep medical costs from increasing even faster than they are. I expect were going to see more efforts on the part of the medical and insurance establishment to make us more intelligent consumers of medical services and keep costs in reign.
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Re: Urgent Care Centers - When should they be used?

Post by S&L1940 » Sun Mar 22, 2015 5:01 pm

Urgent care locations are plentiful in our area; usually there is a MD on site but perhaps not seeing every walk-in
My one occasion for their use got me referred for an MRI for a persistent backache (they took an X-ray) and a need for major surgery was discovered. Calling a doctor for a same day or same week appointment is not an option here and true medical emergencies are always best served at the ER. Best way in is by ambulance/EMS for immediate attention but you better truly need it or that can be an expensive ride - like $400 to $500. stay well, Rich
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Re: Urgent Care Centers - When should they be used?

Post by SleepKing » Sun Mar 22, 2015 5:29 pm

Only use urgent care for non-lifethreatening, non-chronic 'urgent issues'. Examples: I sprained my ankle, I need a strep test, I stepped on a nail and need a tetanus booster.

Only use Emergency Department for life threatening issues. Examples: I have new and atypical chest pain, Grandma suddenly fainted and we don't know why, Johnny fell off the singlet and he has bone sticking out of his arm. If you show up to the ED with a non-life threatening issue expect to wait a while, they are dealing with treating and triaging very, very sick patients at all hours of the day.

Use your PCP for non-lifethreatening 'urgent issues' and everything else EXCEPT life threatening emergencies. Most PCP clinics I am familiar with have 'sick visits' built into their daily schedule. If your PCP can't see you, one of his partners usually can. Examples: Everything from the urgent care example in addition to: my chronic low back pain is kicking up, i have the flu, my blood sugars have been running high since adjusting the insulin regimen, etc.

With that said, urgent care clinic quality and scope of practice can vary greatly. Know your local resources and choose wisely. Many have residents moonlighting or staffed mostly mid-level providers. That means that laceration on your forearm could be treated by a plastic surgery resident, a neurology resident, or a mid-level who works there on the weekend.

Last time I went to one was almost 10 years ago when I needed my ear canal irrigated (water plugged behind some wax). Charged me almost $200 bucks after co-pay...but WELL worth it to resolve my symptoms after my PCP hours were closed!

Sleepy

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Re: Urgent Care Centers - When should they be used?

Post by Hayden » Sun Mar 22, 2015 5:55 pm

The problem is, as a lay person, it is hard to know. I still think I'm a young person, so I believe things like heart attacks and strokes can't happen to me. When I had a problem once, I went to UC. When an older friend had a problem, I took him to the ER.

In my case, I err on the side of not going to the Dr., probably to my detriment. I probably would be better off if I made greater use of UC (getting in to see my PCP is virtually impossible).

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Re: Urgent Care Centers - When should they be used?

Post by ERMD » Sun Mar 22, 2015 7:46 pm

as someone who works in both an emergency department and an urgent care center, i will tell you that the simple answer is: if you would go to your primary care doctor for your problem, but can't, go to the urgent care center. otherwise, go to the emergency room.

if you aren't sure, err on the side of going to the emergency room. but be prepared to spend half the day there (at least).
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Re: Urgent Care Centers - When should they be used?

Post by jlawrence01 » Sun Mar 22, 2015 7:52 pm

SleepKing wrote:Only use urgent care for non-lifethreatening, non-chronic 'urgent issues'. Examples: I sprained my ankle, I need a strep test, I stepped on a nail and need a tetanus booster.

Only use Emergency Department for life threatening issues. Examples: I have new and atypical chest pain, Grandma suddenly fainted and we don't know why, Johnny fell off the singlet and he has bone sticking out of his arm. If you show up to the ED with a non-life threatening issue expect to wait a while, they are dealing with treating and triaging very, very sick patients at all hours of the day.

Use your PCP for non-lifethreatening 'urgent issues' and everything else EXCEPT life threatening emergencies. Most PCP clinics I am familiar with have 'sick visits' built into their daily schedule. If your PCP can't see you, one of his partners usually can. Examples: Everything from the urgent care example in addition to: my chronic low back pain is kicking up, i have the flu, my blood sugars have been running high since adjusting the insulin regimen, etc.

With that said, urgent care clinic quality and scope of practice can vary greatly. Know your local resources and choose wisely. Many have residents moonlighting or staffed mostly mid-level providers. That means that laceration on your forearm could be treated by a plastic surgery resident, a neurology resident, or a mid-level who works there on the weekend.

Last time I went to one was almost 10 years ago when I needed my ear canal irrigated (water plugged behind some wax). Charged me almost $200 bucks after co-pay...but WELL worth it to resolve my symptoms after my PCP hours were closed!

Sleepy

Good advice. Do realize that MOST hospitals, especially suburban ones, have urgent care centers, staffed by MDs, partially in an effort to relive congestion on the over-taxed ED. I can say from personal experience that if you show up at most of these Urgent Care Facilities when you should have gone to the ER, they will send you immediately to the ER, by ambulance.

My physicians ask that we head to Urgent Care Centers when we have non-emergency issues when they are not available, especially at night and on weekends. Personally, I try to avoid them as it requires a full medical history. If possible, I try to see a doctor in the large practice that I use. I have had nothing but praise for the staff that I have been treated by. Since they are under the same hospital umbrella, they do a good job communicating with the PCPs.

As for insurance companies, they tend to prefer their use as opposed to running into the ER.

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Re: Urgent Care Centers - When should they be used?

Post by archbish99 » Sun Mar 22, 2015 9:20 pm

fsrph wrote:So where do you go in that case? I don't have the answer but hopefully a good Urgent care facility will send you to the ER asap if they can't handle the problem.
Our local urgent care is in the same building as the ER. We have been sent upstairs by triage before.
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Re: Urgent Care Centers - When should they be used?

Post by pondering » Sun Mar 22, 2015 10:40 pm

I took my Mom to an urgent care center twice, had her got to her doctor twice, and to the orthopedic surgeon once in her last year of life. All of them missed her stage four cancer, with the urgent care doctor who thought she had a rotator cuff injury telling me he didn't want to diagnose it because he couldn't prescribe the PT for it (her complaint that day was about her digestion, which was handled appropriately). I'm not sure the system failed, because I'm not sure my Mom wanted to be here anymore, she had early onset dementia.

I'm forever grateful to her brother and sister who came to visit as soon as they could after she got a 1-2 months to live diagnosis from the hospital. The cancer was discovered by an emergency room doctor when she smoked out her apartment after falling asleep over boiling an egg.
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Re: Urgent Care Centers - When should they be used?

Post by willie838 » Sun Mar 22, 2015 11:39 pm

from my experience they're used in my pub sector job primarily as a way to get on paper quickly if you have a work related injury, or if you need a doctor's note to justify extended absences from work.

i don't know of people using them over a primary.

Such is the nature of paperwork in my pub sector job.

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Re: Urgent Care Centers - When should they be used?

Post by Naismith » Mon Mar 23, 2015 2:01 pm

Also, be forwarned that there is such a thing as a freestanding ER. They have radiology and some other services onsite, and an ambulance always waiting, but in one case the facility is more than 9 miles from the parent hospital. Yet they bill at ER prices. It can be a shock if you were expecting an urgent care bill, which may be the same co-pay as a primary care provider.

And in my town two former Urgent Care facilities have been transformed into these free-standing ERs, so it can be confusing.

When I had a little bike accident and wasn't sure if my toes were broken and whether I should cancel my vacation, I went to an urgent care. Unfortunately, they take people in the order they come, and there were like a dozen sports physicals before me. So we left and went to a freestanding ER. They got me in immediately, had my records from previous interactions with that hospital, and took the films. I also appreciated that when the breaks were confirmed, they did not insist on making me an orthapedic boot; when I told them I would wear my hiking boots for protection, the doc thought that made perfect sense and would be even better. The total bill was around $200, but our time is worth something too, so that was not a bad deal.

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Re: Urgent Care Centers - When should they be used?

Post by katnok » Mon Mar 23, 2015 2:19 pm

A couple of thoughts related to UCs:

I am not sure about Urgent Cares in cities, but in my small community (there are about 5 in a radius of 15 miles), ALL without exception provide poor quality of care. The providers, most of the time an NP or a PA, try to please the patients and give them whatever they want. Clearly, most are incompetent.

From UC perspective, money is the main driver of their business, while quality of care is something way at the bottom.

Unfortunately, patients/parents can not always discern/judge the quality of care, but other medical professionals in the community can easily do.

Please don't judge the quality of care based on how nice the provider/physician is. There are quite a few of these physicians who are not perceived as nice by most, but they do the best job.

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Re: Urgent Care Centers - When should they be used?

Post by DFWinvestor » Mon Mar 23, 2015 2:56 pm

I am an ER physician by training. I have staffed Urgent Care Clinics on a part time basis in the past but no longer do so. It's difficult to come up with any concrete guidelines for the layperson, because every clinical scenario is different.

But here is a list of things that definitely should NOT go to Urgent Care in my opinion, and instead straight to the Emergency Department:

1) Anyone older than 65. Some UC's don't even accept medicare. Even if they do, the elderly population is more likely to need an extensive workup and you are probably better off in the ED. Exceptions would be if you are incredibly healthy and have a very minor issue; ie NO underlying medical problems and have minor URI symptoms, an ankle sprain, a superficial laceration.

2) Anyone under 6 months. I don't think most UC clinics have enough experience with the very, very young. Some facilities I have staffed previously would not even evaluate children younger than six months. Even those that will I would not recommend it for children < 6 months

3) Chest Pain in any age group

4) Shortness of Breath in any age group

5) Headaches in any age group

6) Vomiting/diarrhea unless symptoms are minimal. In which case you could probably stay home. Many of these facilities have nurses who do not start IV's very often, and have limited lab capabilities.

7) Abdominal Pain. Most facilities do not have a CT scanner/ultrasound capabilities, or will not be able to get all the necessary labs done and back during your visit.

8) Any neurologic deficit. Arm feels tingly/numb, weakness in an extremity, speech difficulty, facial drops, generalized weakness (which is not likely neurologic in origin but could be due to a number of underlying medical issues).

9) Fainting spells and/or palpitations/light headedness

10) Anyone who has multiple serious medical problems (cancer on chemo, taking blood thinners at home, frequent hospitalizations for any reason)

11) Head injuries or any motor vehicle collision or other serious traumatic injury------if you have anything aside from an isolated extremity injury. I would always cringe when people would come in UC and say, "well I was in a car wreck, and I refused EMS, and I thought I'd just come over here. I am having neck pain, and a headache, and my abdomen is sore". These patients really put themselves in jeopardy by going to the wrong place, and they are going to need a transfer under most circumstances. Urgent Care is NOT equipped for handling people with significant traumatic mechanisms.

12) Serious extremity trauma (think angulated deformity). Most UC's will not have the capability to address these kinds of injuries.


This is not an all encompassing list but a pretty good start. I could probably come up with more but this is a good general guideline. And I suppose I should mention this in no way implies I have established a patient/physician relationship with anyone:)

What I would suggest is researching the UC's in your area before you have a need. The capabilities of UC clinics is highly variable. And whenever you are on the fence I would opt for the Emergency Department as a precaution.

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Re: Urgent Care Centers - When should they be used?

Post by coalcracker » Mon Mar 23, 2015 3:09 pm

Think twice about taking your child to a *general* Urgent Care center. They are often staffed by doctors, NPs and PAs who have limited experience working with children. My wife is a pediatrician, and she has come across many cases of incorrect medication doses, inappropriate management, etc. This is more the rule than the exception in her experience.

The children's hospital in our area does run several Urgent Care centers around town, which obviously do a much better job with children :D

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Re: Urgent Care Centers - When should they be used?

Post by bungalow10 » Mon Mar 23, 2015 3:15 pm

We have used urgent care for minor injuries - I stepped on something and needed a tetanus booster, my daughter cut her foot at a water park, kid develops high fever on a road trip...

We have a third option with our insurance - Teladoc. Talk to a doctor on the phone, they will even get you a prescription. No visit necessary.
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Re: Urgent Care Centers - When should they be used?

Post by Pajamas » Mon Mar 23, 2015 4:00 pm

Basically, use the urgent care center when you would normally go to your doctor but your doctor's office is closed.

If you would normally go to the ER for something rather than to your doctor, you should still go to the ER.

But it depends on the particular urgent care center because there may be some services that they can provide that your doctor might not. Some urgent care centers have complete facilities and lots of specialists while some primary care doctors don't do simple sutures. Other urgent care centers may be lightly staffed and send everything that can't be solved with a prescription to the ER.

Before going to an urgent care center for anything complex, you could call and ask if they can handle the problem or if you should go to the ER.

I have been to an urgent care center for minor sutures and a bad sinus infection that couldn't wait the rest of the weekend.

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Ricola
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Re: Urgent Care Centers - When should they be used?

Post by Ricola » Mon Mar 23, 2015 4:13 pm

Well I may be having to use them more now that my family practice doctor of over 10 years just announced he is going Concierge (MDVIP). Wants $1800 per person per year just be on his patient list. So $1,800 x 4 = $7,200 yr plus $14,400 yr medical insurance and your ups to $21,600 per year before even making an appointment. :oops:

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Re: Urgent Care Centers - When should they be used?

Post by bungalow10 » Mon Mar 23, 2015 4:39 pm

Ricola wrote:Well I may be having to use them more now that my family practice doctor of over 10 years just announced he is going Concierge (MDVIP). Wants $1800 per person per year just be on his patient list. So $1,800 x 4 = $7,200 yr plus $14,400 yr medical insurance and your ups to $21,600 per year before even making an appointment. :oops:
WHOA!!! That is crazy.

I shoulda been a doctor...
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Re: Urgent Care Centers - When should they be used?

Post by katnok » Mon Mar 23, 2015 4:56 pm

coalcracker wrote:Think twice about taking your child to a *general* Urgent Care center. They are often staffed by doctors, NPs and PAs who have limited experience working with children. My wife is a pediatrician, and she has come across many cases of incorrect medication doses, inappropriate management, etc. This is more the rule than the exception in her experience.
+1.
Totally agree with this.

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Re: Urgent Care Centers - When should they be used?

Post by eschaef » Mon Mar 23, 2015 9:40 pm

Personally? Broken ankle (told me it was sprained, but set me up with x-rays and crutches until I could get to a "real" orthopedist to read my x-ray), antibiotics for strep throat (multiple times), antibiotics for a badly infected bug bite (multiple times), antihistamines and steroids for an allergic reaction (hives). In an out in under an hour. 5 minutes from home. Convenient hours and the ability to walk in without an appointment. If it doesn't involve an altered level of consciousness, potential breathing or cardiac issues, or a significant trauma, the ER doesn't need me taking up their time and I don't want to wait hours for my turn to be seen. (Maybe add severe pain to that list... If I thought I might have appendicitis or kidney stones or something like that, I'd also go right to the ER.)

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Re: Urgent Care Centers - When should they be used?

Post by ClevrChico » Tue Mar 24, 2015 10:02 pm

We've recently used it for sick kids on the weekend for strep and each infections. That way they're healthy sooner and can be back at daycare on Tuesday.
.

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Re: Urgent Care Centers - When should they be used?

Post by saladdin » Wed Mar 25, 2015 10:18 am

coalcracker wrote:Think twice about taking your child to a *general* Urgent Care center. They are often staffed by doctors, NPs and PAs who have limited experience working with children. My wife is a pediatrician, and she has come across many cases of incorrect medication doses, inappropriate management, etc. This is more the rule than the exception in her experience.

The children's hospital in our area does run several Urgent Care centers around town, which obviously do a much better job with children :D
Ease up on the dramatics. Your wife was one of those unexperienced doctors at one time, she isn't special.
I've had more "expereinced" doctors who are slow to change give bad/wrong medical advice than those from urgent care.

I bet some of your apprehension is because of the vicious caste system that MD's use when talking NP's and PA's.

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Re: Urgent Care Centers - When should they be used?

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