By Anna Holman
In Urgent Care, fall means the beginning of cold season, where patients with sore throats start to fill every other room. As a medical student, these visits are pretty straightforward, however, the challenge comes with the conversation surrounding treatment. Patients with cold symptoms don’t usually come into Urgent Care for Tylenol and nasal saline irrigation. Most people are already doing some version of symptomatic management before they come in. They often come in because they think they need antibiotics. In the cases where the symptoms seemed to be viral in nature and antibiotics were not indicated, I realized how important it is to validate the patient’s experience of their illness while explaining the treatment plan. Patients who were more insistent about antibiotics often had a history of a similar illness for which they received antibiotics and found improvement.
One patient I saw had a long history of sinus infections, multiple sinus surgeries, and the chronic sensation of sinus congestion. She pleaded for us to give her antibiotics, telling us that she only feels like she can breathe normally when she is on antibiotics. She had just finished a 10 day course of antibiotics and wanted another 2 weeks to take until she had another surgery. Without a relationship or knowing the patient’s history, the visit was more challenging than a visit as a primary care provider might be. We tried to explain why chronic antibiotics could be harmful and not likely to improve her symptoms. I am not sure the patient was very satisfied as she left the clinic without antibiotics in hand, however I won’t ever really know how much our conversation sunk in with her.
Working in Urgent Care reminded me of how much I like to have follow-up and to develop relationships with patients. As a medical student with short rotations, it is fairly uncommon to see a patient over a long period of time, but even just seeing a patient twice in a rotation felt gratifying to me. In my Urgent Care rotation, I would suture a laceration, but hardly ever got to see how the laceration healed. In this way, it was harder to learn from mistakes and I was left just hoping that my knots held and the scarring was minimal.
The Urgent Care setting is a good middle ground for patients. It is less intense than the Emergency Department and I found that many patients preferred the Urgent Care to the Emergency Department. For this reason, it was crucial to quickly identify which patient conditions were beyond the scope of the Urgent Care setting. This was never a black and white decision. People often tell me “Patients don’t read the textbook” and I found this to be especially true in this setting. Chest pain and abdominal pain in the Emergency Department is fairly straightforward because of protocols and the availability of advanced labs and imaging. Chest pain and abdominal pain in the Urgent Care setting involves a little more subjective sensing of a patient’s condition and an emphasis on the physical exam for objective findings. In the end, it was often a judgment call and “better safe than sorry” principals that won over conservative management. I never regretted sending a patient to the Emergency Department, but again, I still wished for the follow-up visit to see how everything turned out.
Urgent care is a unique area of health care, a setting I had never considered when choosing to pursue a career in family medicine. I saw a wide variety of medicine and again saw how important it is to develop good rapport with patients, no matter how short the relationship may be. The basic principles of good history taking and a focused yet complete physical exam were key to management, but so was having a subjective sense of patient acuity.
Anna Jackson Holman is a fourth year Medical Student at the University of Utah going into Family Medicine.
Family Medicine Vital Signs 