Urgent Care As A Career

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so how do you deal with that
even in primary care its hard to "deny" antibiotics to people

In primary care, you typically have a longstanding relationship with the patients, and they're usually more likely to trust you when you tell them they don't need abx.

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In primary care, you typically have a longstanding relationship with the patients, and they're usually more likely to trust you when you tell them they don't need abx.

Is there any way to get around that in urgent care? Or do you just not have enough time to build that kind of rapport with the patients that they’ll trust you?
 
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Is there any way to get around that in urgent care? Or do you just not have enough time to build that kind of rapport with the patients that they’ll trust you?
It depends. If you don't care about satisfaction scores, its pretty easy.

Otherwise its almost impossible.

My anecdote: I was very strict about antibiotics when I did a year of urgent care. Ended up with the worst satisfaction scores in the entire system. Opened my DPC practice literally half a mile from that urgent care. Still every bit as strict about antibiotics. In 2 years I only lost 2 patients over that policy.
 
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In primary care, you typically have a longstanding relationship with the patients, and they're usually more likely to trust you when you tell them they don't need abx.
True but I'm saying if it's your first or second visit with a patient they are less likely to rate you positively if they came for URI and you do not give them antibiotics
Btw how important are positive reviews in urgent care
My review are ****TY always but my schedule is always full, ****yy reviews 99 % come from people who I denied benzodiazepines or narcotics
 
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Is there any way to get around that in urgent care? Or do you just not have enough time to build that kind of rapport with the patients that they’ll trust you?

- Besides rapport building, not caring about what they think about you is a good start.
- Being confident in your medicine is helpful too. Often times I see people give out Rx "just incase". There should be this scenario, as it leads to patients only being blinded to them getting what they want.
- The other technique that I personally use is to tell them its a URI, viral. Just follow up with them in 48-72 hours, and see how the patient is, this makes them feel good generally, at which point you can suggest other symptomatic therapies. This is helpful for those that make the UC their PCP office, so you would have built a ''rapport''. So next time they come in, and you tell them this, they trust you..
- Sometimes explaining pathophysio is important too.. i.e. 3 days of cough, than ST.. this is likely mechanical vs. getting Strep.
- At the end of the day, even if you do all of this, there will still be 1 or 2 who will call you a ****ty doc/threaten litigation because you didn't give them an "Z pack". For them its much easier to do this and than go else where. PCP's wouldn't face this because than they know they don't have any good follow up options besides establishing a new PCP (which can be a pain in the ass).
 
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- Besides rapport building, not caring about what they think about you is a good start.
- Being confident in your medicine is helpful too. Often times I see people give out Rx "just incase". There should be this scenario, as it leads to patients only being blinded to them getting what they want.
- The other technique that I personally use is to tell them its a URI, viral. Just follow up with them in 48-72 hours, and see how the patient is, this makes them feel good generally, at which point you can suggest other symptomatic therapies. This is helpful for those that make the UC their PCP office, so you would have built a ''rapport''. So next time they come in, and you tell them this, they trust you..
- Sometimes explaining pathophysio is important too.. i.e. 3 days of cough, than ST.. this is likely mechanical vs. getting Strep.
- At the end of the day, even if you do all of this, there will still be 1 or 2 who will call you a ****ty doc/threaten litigation because you didn't give them an "Z pack". For them its much easier to do this and than go else where. PCP's wouldn't face this because than they know they don't have any good follow up options besides establishing a new PCP (which can be a pain in the ass).
I've found the "just in case" scripts work in primary care but not so much urgent care.
 
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The other technique that I personally use is to tell them its a URI, viral. Just follow up with them in 48-72 hours, and see how the patient is, this makes them feel good generally, at which point you can suggest other symptomatic therapies.

That’s what I did on the ship. But it was a lot easier because I could just walk over to their berthing and ask how they’re doing.

So what do you do when they threaten you? Tell them to take a hike? Just give them what they want?
 
That’s what I did on the ship. But it was a lot easier because I could just walk over to their berthing and ask how they’re doing.

So what do you do when they threaten you? Tell them to take a hike? Just give them what they want?

Yep.
I'm confident in my medicine, and I know if I practice evidence based medicine, that's the standard of care, even if they threaten to complain to the board or litigate me, it won't have merit, and it won't go anywhere.

Alot of the times, those people that threaten for an Rx are doing it just for drama/attention because they think we are in a business oriented model where if they paid for something, they should get what they want.
 
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Yep.
I'm confident in my medicine, and I know if I practice evidence based medicine, that's the standard of care, even if they threaten to complain to the board or litigate me, it won't have merit, and it won't go anywhere.

Alot of the times, those people that threaten for an Rx are doing it just for drama/attention because they think we are in a business oriented model where if they paid for something, they should get what they want.
I've had several employers who would say that they are correct
 
Because they'll just get them filled anyways.. all the same lol

In Miami, I kind of stopped caring. Because all the patients know that if they go to a pharmacy in certain neighborhoods, they can buy amoxicillin, Augmentin, Z-packs, Keflex, and Cipro over the counter without a prescription. Others have relatives from Cuba or the DR sending them antibiotics regularly. So...:shrug:
 
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In Miami, I kind of stopped caring. Because all the patients know that if they go to a pharmacy in certain neighborhoods, they can buy amoxicillin, Augmentin, Z-packs, Keflex, and Cipro over the counter without a prescription. Others have relatives from Cuba or the DR sending them antibiotics regularly. So...:shrug:

Wow, really? That's really interesting.. there isn't any investigation from the board?
 
Wow, really? That's really interesting.. there isn't any investigation from the board?

Not as far as I can tell. People are really open about it, too. At first I was mystified where all these people were getting amoxicillin from - it seemed like a city full of people who hoard old prescriptions. But then a patient told me that "I was feeling a cough coming on, so I went and bought some amoxicillin, but it didn't help." That's when my medical assistants filled me in on this.

A lot of people in Miami come from countries where you can buy a wide variety of medications without a prescription, so they're really confused when you tell them that they have to come in for a visit. They're also from countries that tend to have a LOT less regulation than we do here, so they're just accustomed to a certain level of...."legal laxity," shall we say.

(On a side note, it's even weirder when they come in because they can't find the medication that they used to take back in Argentina/Colombia/Uruguay, etc. It's usually because it's a medication that no one in the US uses anymore for that condition - like the patient who told me that she used to use Dexa-Teosona for her acute asthma exacerbations, but couldn't find it in Miami. That's because Dexa-Teosona is dexamethasone and theophylline, and the idea that you can buy this combination over the counter in certain countries is just mind boggling.)
 
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