THE DOCTOR IS IN . . .

Charles Schultz created the “Peanuts” cartoons of years past, and perhaps you recall the familiar Lucy, sitting curbside, in a type of converted lemonade stand, with a sign overhead, proclaiming “The Doctor is IN” for the purpose of giving advice to the ever-discouraged, ever-confused, ever-anxious Charlie Brown.

I haven't seen any MDs with curbside consultation stands, and one can say that we might wish our MD would be so easily accessible. Let me attempt to describe various types of healthcare delivery systems, and a consumer's guide for discerning which to select among all the choices.

There are many categories of providers of healthcare, and different medical specialties among physicians. There are also various settings in which one might receive health care. In the case of healthy individuals, their health care is usually provided by a family practice physician or a general practice physician. When the patient has chronic conditions that impact overall health, it is common that physicians with specialty designations also participate in care, such as an allergist or an orthopedist. As one's health status involves more than one or two physicians, most often one of them is designated as the primary care physician (PCP); often this is an internal medicine specialist. WORD TO THE WISE, if your care is not centered within one healthcare provider group exclusively, BE SURE that each physician you visit has a complete list of all your medications and vitamin supplements, as well as your allergy list. Do not assume that your eye doctor doesn't need to know about your blood pressure medications, for example. When you do see physicians at different locations, ask to sign a release of information form so that the health information from another doctor will be shared with your PCP. This is for your own safety and on-going consistency in care, over time.

Some thoughts on establishing care with a primary care physician for yourself and your family: None of us makes plans to be sick or sustain an injury. No one intends to break a leg—that's why such happenings are called accidents. And accidents can happen at any time, to someone of any age. Often someone goes to the first appointment available at any clinic to find relief for a cold, a rash, or hayfever. If, then, in two weeks the person isn't improved, s/he may go to a different clinic because it's near home or work, and s/he may not report the treatment given before, which results in first-line treatment given a second time---which doesn't work any better than the first time. To the contrary, going to the same provider allows for more in-depth assessment and reconsideration for a change in the approach to treatment.

None of us has any assurance that our health needs will occur during “normal business hours” for a health care clinic. Our primary physician would be your first choice. The reality is that often when you call that clinic for an appointment, there is some negotiation regarding how soon you might be seen. If your PCP is unavailable at a time that works for you, you may want to accept an appointment for another physician or nurse practitioner or physician's assistant in the same clinic This provides continuity of care, allowing your PCP to be aware of your illness and initial treatment. That information is at hand, if follow up visits are needed. Despite the best recommendation to have 'your own' physician provide all your healthcare, there may still be a need for the next-best type care. Those accidents and sudden-onset symptoms can be those things that require immediate care. 

There are urgent care centers that are located within a larger clinic or hospital; there are other urgent care centers that are 'free-standing' or located within a Target or Walgreen's store, for example. Urgent care services are medically necessary services which are not life-threatening but need some attention within 24 hours. An urgent care center does not typically have anything more than very basic diagnostic equipment, for evaluating basic lab work and uncomplicated xrays. Examples of some conditions that are treated in urgent care: allergic reactions, rashes, sore throat, sinus infections, pink eye, ear infection, bug bites, sprains, lacerations, migraine, diarrhea, vomiting.

It's important to keep an Emergency Department free of 'busy work' that should have gone to urgent care, so that the Emergency Department can focus on true emergencies. Statistics show that about 30% of cases in the Emergency Department could have been successfully treated in urgent care. So how do you decide? Here are some more guidelines for situations that should go directly to ER: chest pain or other heart attack symptoms – call 911; multiple broken bones, or bones protruding through the skin; head injuries with or without multiple trauma, loss of consciousness, severe headache, sudden vision loss; overdose; suicide attempt; severe bleeding; poisoning.

It is important to pay attention to, and comply with, your home-going instructions from urgent care, emergency care, or hospitalization. Most often you will be instructed to follow up with your personal physician. If you don't have one, this is the motivation to schedule an appointment at the clinic of your choice to establish care. The reason for this follow up is that there frequently can be complications of your condition which would have been symptomatic within that period of time, generally one-to-two weeks.

There is one additional healthcare provider to keep in mind. The larger orthopedic (bone) specialty clinics in the Twin Cities metro area have their own Urgent Care facilities fully staffed with xray and MRI capabilities, and with physicians to provide diagnosis and treatment on-site. Hennepin County Medical Center (HCMC) has their Fast Track Ortho Clinic for acute injuries and/or fractures. That department is open Monday through Thursday from 1 p.m.- 8 p.m., and Friday from 1 p.m. - 5 p.m. After those hours of service, HCMC Emergency Department will assess and treat orthopedic injuries. Twin Cities Orthopedics has several clinics in the metro area including Edina; their Urgent Care facility hours are8 a.m- 8 p.m. Walk ins are welcome. TRIA, an orthopedic specialty clinic, also has urgent care services 8 a.m.-8 p.m. Walk-ins welcome there, as well. It is this writer's recommendation that an injury with suspected fracture be evaluated and treated at one of the orthopedic specialty urgent care facilities; it saves a lot of time, and frequently avoids a secondary referral.

Charlie Brown, his friend Lucy, and the 'Peanuts' gang, together with your parish nurse, remind you “The Doctor is IN . . .”