Don’t Create A Problem Out Of Your Urgent Care Shift

I see some colleagues struggling quite a lot with their work shift. For the veterans out there we all know there is really no such thing as a difficult day, a complicated patient, a hard shift. The acuity is really dependent on the particular urgent care you work at and only way to change that is to work at a lower acuity facility.

Sure, some days the patient volumes will be low/high. Some days you will have to curbside the specialist, manage some cumbersome med refills and navigate insurance authorizations. In the end you are still working with a set number of resources and a set criteria that you hopefully have developed for your particular practice style by now.

Unpredictable Factors In The Urgent Care Setting

Assuming you are comfortable with the patient acuity at your urgent care, it’s really patient volume and staff that are the major unpredictable factors. Patients have been ‘patients’ for thousands of years. They will be needy, sick, scared, demanding, rude, bossy, smelly and non-compliant. As for coworkers, they may be having a bad day, may have it out for you or may just be incompetent.

I think having an expectation is where the problem starts. If you go in the room with a patient and come out and are appalled that they went off on you or were drug-seeking etc., then you expected that the patient would be a certain way which makes no sense.

This is true even with your staff. You may go into the room and see that the chart doesn’t have certain vitals, or that the nurse took forever to check a patient in. There may even be serious mistakes made in checking in a patient. Naturally, as a clinician you will address any short-comings with your staff and tell them how they could do it differently. If they continue to do it you can either work with a different nurse, let their supervisor know or …. just do whatever you can yourself.

No Expectations = Liberation

Don’t expect that you will get a lunch, if it’s a really busy day then you likely won’t. Don’t expect it to be an easy day, or hard for that matter. The day will be the way it will be. You need to just accept it and do what you can to do what you are hired to do. It can be quite liberating once you let go of this expectation and just surrender to the good and the bad – yes, I just dished out some Zen-shit but it works.

Too Cold – Too Hot – Never Just-Right

One colleague I work with comes out of nearly every room and has something that he complains about. Just the other day he complained that one patient who came in for 3 days of URI symptoms could have totally managed things herself without needing to come in. Then he came out of the next room and complained that the other patient was too sick to be in the urgent care and should have self-directed himself to the ED.

Another doc I work with argues with every nurse she works with except one or two of them. She will tell the nurse that they took too long with one patient, didn’t prep another patient properly, didn’t do a strep swab, didn’t have a peak flow on an asthmatic etc. It never ends.

Give Up Control And Just See Patients

My solution… come to work a little ahead of your starting time. Smile, set your mood by cleaning your station, getting a cup of coffee and maybe chatting with your staff a little. Triage and treat each patient based on your own set limits. If a patient appears ill and needs monitoring then direct admit them to the hospital. If you don’t do cardiac workup in your urgent care then send them to the ED. If an abscess is too complex for you to manage outpatient then send them to the ED.

Don’t keep looking ahead on your schedule just to complain that the 94 year-old with fever and fatigue shouldn’t be in your urgent care. Or that a 9 day old with weight loss and a rash needs a pediatrician. We all know that the pregnant woman with abdominal pain could just be there for a rib injury once you get the whole story.

We are urgent care providers. We see the shit that just doesn’t fit into a particular place right off the bat. Trust me, the patient with the hand amputation likely won’t come to your urgent care. The patient with a hang nail likely will try grandpa’s home remedy. Remember, you are expected to work within your comfort zone. Manage the patients as best as you can and send the rest out for higher level of care — or home.

Other Helpful Sanity-Sparing Tricks In The Urgent Care

curbside another colleague on a difficult case
bring a sick patient back for a 24-hour recheck in the urgent care
give out your cell-phone and have a patient update you if you’re afraid that they might get lost to follow-up
place future lab/x-ray orders for the patient to do if they get worse
order post-dated future antibiotics for the patient to pick-up if their symptoms worsen as expected with a bacterial infection
if a test isn’t covered by the patient’s insurance in your group give them a script to go get it done at a private facility; you would be amazed how cheap tests are these days when paid for in cash
take pictures of x-rays, EKG’s, rashes and wounds and text them to medical colleagues, especially specialists for a quick second opinion

What tricks do you use to make your shift go by easier?
What irritates you the most during your shift?