Despite the fact that many people have difficulty finding a family physician, there remain many options for medical care. From emergency departments to urgent care clinics to clinics based in retail stores and pharmacies, there are several different ways to see a physician, physician assistant, or nurse practitioner.
This can be useful when one has no family physician, or can’t get an appointment. It can be difficult and downright dangerous when a person with a persistent medical issue goes from place to place seeking a better answer, better treatment, or in hopes of getting a medicine or test she or he thinks is necessary.
Let’s say that a child has a fever. The pediatrician examines the child and says the child has a viral head cold. The fever, as predicted, continues. In 2 days, on the advice of family, frustrated parents go to an urgent care. There, the diagnosis is an ear infection, and an antibiotic is started. On day 6, the diarrhea starts (antibiotics often do this), and the fever continues, as it so often does with viral illnesses. The parents then take the child to the emergency department of the local hospital, where tests may be done and which might (or might not) show something else to treat.
By day 8, the symptoms are all gone. The temptation is then to believe that the first doctor was wrong, and that the second and third did something useful. That may or may not be true. But what is true is that unnecessary money may have been spent, potentially unnecessary drugs given, and possibly unnecessary x-rays obtained.
The same sort of thing can happen with even worse consequences when a person has a procedure and complication. For instance, a gallbladder surgery is done in one hospital, but when a fever develops 2 days later, the patient goes to a local pharmacy clinic. From there, the patient is sent to the urgent care for some other test and later ends up in the emergency department when symptoms worsen.
Perhaps the surgeon was never contacted, by the patient or anyone else. The surgeon might have been very alarmed by the fever and have asked the patient to come immediately to the office, where her expertise in these things would have been much more expeditious. (And probably cheaper.)
Because medical problems can be very complex and confusing to patients, it’s easy for important details to be neglected when one sees a new physician or goes to a different clinic; in that case, disastrous results can occur.
Furthermore, despite electronic medical records, most facilities are not connected. So a visit to a new place is often a visit without one’s old records, and the details of other visits are not immediately available.
My point is that continuity matters. An emergency is an emergency and one should seek treatment. But sometimes the convenience of going to a different place for a non-emergency results in confusion for patient and physician, increased cost, unnecessary treatment, and unpredictable, sometimes dangerous, complications.
Edwin Leap, MD, is an emergency physician who blogs at edwinleap.com and is the author of The Practice Test and Life in Emergistan.
This post also appeared on KevinMD.
Last Updated September 24, 2020
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