Only Worry About the Patients Who Are Already Roomed
I see this in my colleagues a lot… getting stressed out over what pops up on their schedule. Several of us are dedicated urgent care docs. Our schedules all vary but I would say the majority of the docs are part-time. Our medical group has several urgent cares which are all walk-in based. However, because there is usually high demand we start seeing the schedule fill up as soon as the doors open. The patient’s name and age will show up on the schedule along with whatever blurb the front desk staff put down in regards to the chief complaint.
Why, Oh Why! ANOTHER rectal bleed??
Some docs seem to torture themselves for no good reason. The majority scrutinize their schedules and routinely look and see who is put on their schedule with what complaint. On the flip side a few of us don’t even bother looking… mostly because we have enough faith in the nurses to screen the sicker ones and let us know about them or move them to the front of the line. Even if that doesn’t happen we have enough experience to know that just because the c.c. reads “abd pain and LOC” or “fever & abd pain & blood” or “chest pain, dizziness, numbness” it doesn’t mean that those patients have anything serious going on with them.
The Chief Complain is Often Pleasantly Deceiving
A patient with c.c. of “abd pain” could just be having a floating rib pain. They could be constipated, they could have an abdominal wall muscular pain. What is the purpose of scrutinizing the schedule in so much detail and driving yourself nuts? Here is one of my typically bad analogies – your investments; do you look at them minute by minute even if you know that you won’t act on the information?
If you were the unit nurse and you were screening the schedule for abd pains, chest pains, SOB etc then sure, it would make sense to constantly look. You would need to identify those patients, perhaps order some tests on them and move them up in the schedule if necessary.
My advice to anyone working in the urgent care is don’t look too far down your schedule. Don’t loose your cool if you see:
- 37yo F Abd pain, vaginal d/c
- 82yo M Abd pain, fever
- 12yo M Abd pain, nausea
- 10yo M chin lac
- 29yo M forehead lac
- 62yo F shin lac
The reason I say that is because no matter what the patient has/no matter how sick you are still going to go into each room, extract the HPI, do a pertinent exam, order any necessary tests and dispo the patient according to your findings. You will basically follow the 5-step guide to handling an urgent care visit regardless of what’s next on your schedule.
Stay Calm, Cool and In The Moment
I realize that some people think they are quenching their anxiety thirst by looking at the schedule but that only creates this endless loop of more anxiety… needing to look again… freaking out about it and then all over again. And if you keep doing this on slow days you will have no moment’s peace because you will be thinking “What if they put something really difficult on my schedule!”
My recommended steps are:
- Glance at the patient and c.c.,
- Do a quick chart biopsy looking at meds/recent labs/recent visits/PMHx
- Look at what other patients are already roomed and decide who to see next based on that
- If you suspect that you will need to do a procedure then go numb up that patient and while waiting for your nurse to set up for your procedure go see the next patient
Do you look at your schedule or do you take the one-by-one approach?
Does a particular chief complain create anxiety in you?