Today I had a glimpse of what urgent care is like and, maybe, what the PAs/NPs I used to supervise in the ED were up to. (There are some good ones out there, I know. But many are not.) I'm an emergency physician. Retired a few years ago, moved to a new state, so no doctor friends here that I could bug for a quick x-ray. I had a dumb hand injury this morning while trying to get some things done around the house, and by mid-day, there was enough pain and swelling that I gave in and decided to make sure I wasn't making things worse by continuing to try to use it if something was really wrong. I'd only ever been to an ED as a patient once in my life, and that was for an obviously broken long bone before med school. Never been to an urgent care. I'm usually very "rub some dirt in it and walk it off."
Fun fact: Good ole Jesse Pines was my ED physician that day, back when he was a resident.
So I reluctantly went to an urgent care. The PA wrote down my one-sentence history. Didn't ask for any details. Exam consisted of touching the big swollen area and asking if that hurt, then the same proximally and distally, then asking if I could make a fist. No other assessment of ROM. No assessment of sensation. No assessment of circulation. Then off to x-ray, where the reason given to the radiologist was very vague, so he understandably missed the hairline fracture at the base of the 5th metacarpal, which I was able to see when I looked up my images at home.
Also, I didn't want anything for pain anyway, but no one offered anything.
The outcome in this case wouldn't have been any different even if I'd had a perfect hand surgeon history and exam... but I cannot get out of my head the image of the crusty old attending who taught me the hand history/exam and how appalled he would have been today that medicine has declined so much.
Fun fact: Good ole Jesse Pines was my ED physician that day, back when he was a resident.
So I reluctantly went to an urgent care. The PA wrote down my one-sentence history. Didn't ask for any details. Exam consisted of touching the big swollen area and asking if that hurt, then the same proximally and distally, then asking if I could make a fist. No other assessment of ROM. No assessment of sensation. No assessment of circulation. Then off to x-ray, where the reason given to the radiologist was very vague, so he understandably missed the hairline fracture at the base of the 5th metacarpal, which I was able to see when I looked up my images at home.
Also, I didn't want anything for pain anyway, but no one offered anything.
The outcome in this case wouldn't have been any different even if I'd had a perfect hand surgeon history and exam... but I cannot get out of my head the image of the crusty old attending who taught me the hand history/exam and how appalled he would have been today that medicine has declined so much.
