Ms. Common Sense

Ms. Common Sense, meet Dr. Common Sense.

Code 3 for chest pain. At the urgent care clinic.

As you know, we respond to the urgent care clinic quite often, usually for some silliness that exceeds their capabilities, so it’s usually really just some transfer to the ED. The numbers out of this place are on par with your typical skilled nursing facility.

A woman in her 40s experienced some chest pain in Neighborhood A, where she lives. She called her doctor, who is clearly familiar with both this urgent care clinic and the ED, and asked if she should go to the ED, a few minutes away from her home. He said no, and directed her to the urgent care clinic, 15 minutes away in Neighborhood B.

So, she showed up at the urgent care clinic with chest pain, and – lo and behold – they put in a call to the ED, followed quickly by a call to 911. We leave our coffee – I don’t really remember but it sounds cool to type that – and drive from near her home and the ED all the way to the urgent care clinic, and drive her all the way back to the ED.

And now her car is stuck in the parking lot at the urgent care clinic.

“Who is your doctor? And why did you listen to him in the first place?”

8 thoughts on “Ms. Common Sense”

  1. You know, it’s funny because at my med school it was stressed that acute MI = call 911 because EMS knows for sure where the local cardiac hospitals were. Don’t tell the patient where to go, don’t suggest a hospital. Call 911, that’s what they’re there for. You know, the entire emergency thing.

  2. Silly ambulance driver.

    If the doctor directs the patient to the ER, the urgent care he’s affiliated with doesn’t get to bill anything.

  3. This totally reminds me of a frequent Dr. caller. His patient calls the office at 10am for chest pains. She lives next door to the ED. They make an appointment for her to come to the office (15 minute drive) AT 1PM! She gets to the office…well past that golden hour and…you guessed it, we are bringing her to the ED next to her house sans her vehicle. Doctors are not good at thinking sometimes!!

  4. @BH, you nailed it! Too true!
    Also, many insurance companies are cracking down on what is allowed as an emergency and what they will pay for. Also, what was her insurance coverage or did she have any at all? I, too, have gone to an urgent care center for chest pain, due to insurance reasons (we are actually told to go there first, unless it is a TRUE life threatening emergency). Paramedics and ambulances etc, can be really scary to the patient and family alike, esp. when they are not accustomed to them. Different strokes for different folk.

  5. as far as i know, both the urgent care clinic and the ED are part of the same system. no logical reason for him to tell her to go to the urgent care. besides, it’s chest pain from a reliable patient, not toe pain.

  6. A co worker who is on the day shift was recently dispatched to the outpatient cardiac clinic in a major teaching hospital. The patient had come in for a scheduled appointment and the doctor saw “something odd” on the ECG. Instead of calling their contract ambulance service they called 9-1-1.

    On arrival, my friend pointed out that the hospital’s cath lab was down the hall, but the doctor insisted that the patient be transported 1/4 mile away to the ED. Which as my friend pointed out, made no sense since the ED was only going to call the private contract ambulance service to bring the patient BACK to the cath lab.

    Well, as the saying goes, you can be a doctor or you can be smart, but you can’t be both.

    So, over to the ED where before the patient was off the stretcher, the secretary was calling the private contract ambulance service to bring the patient back 1/4 mile to the cath lab.

    Some day, someone is going to file an EMTALA complaint against a hospital and it’s medical staff. Then, when the doctor is on the hook for the fine and the hospital gets it’s fine from CMS, this stupidity will start to change.

    If I knew that I could get 15% of that fine, I’d start a business soliciting this kind of complaint.

    1. the smart medic-cum-lawyers all start off wanting to defend medics, but they all end up looking for medics’ mistakes instead. so the story goes.

      1. Doctors and hospitals have lots more money than paramedics and ambulance services. Really smart medics-cum-lawyers know this.

        A lot more doctors and hospitals get sued than do medics and ambulance services. Of course dopey instructors have scared impressionable paramedic students with boogie man law suit stories for a long time.

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