I just had my first encounter with the US medical system outside of university. The place was part of the Beth Israel Medical Group, called Docs Physicians, and I went as a walk-in to the branch at 55 E 34th. They opened at 9am on saturday morning, so I arrived a bit early and had a coffee and bagel next door before I went in. There were two patients before me, and the wait was short (30 min) even though there was only one attending physician. I told the doctor that the last time I had suffered a prolonged cough from a cold, I had been prescribed an inhaler, and may have accelerated the diagnosis a bit that way. Docter was Keith Uleis, he ended up prescribing an antibiotic (Azithromycin), an inhaler (Albuterol) and a steroid (Prednisone) for inflammation control, after putting me on a nebulizer for 15 min to gauge the possible asthmatic effects. The charge for the consultation was $225, and filling my prescription next door at Pasteur Pharmacy cost $10 (steroid) + $40 (antibiotic) + $50 (inhaler) = $100.
I can’t believe it took me this long to figure out that I needed to go to urgent care – am seriously wondering about the purpose of having a primary care physician, which I spent part of yesterday trying to pick out. The differences: one, familiarity with medical history; two, a more relationship-based, as opposed to transaction-based, incentive system; three, most importantly, scheduling flexibility.
Giving doctors uniform access to standardized medical records gets rid of the first point. As for the second, I dislike decision by anecdotal evidence, which is what the relationship model encourages. What I want is for my accessible doctor pool to be more effectively commoditized, by virture of some standard success record. Urgent care centers may provide that by acruing reputation as a collective and not on a doctor basis.
Tags: bronchitis, cold, docs physicians, manhattan, new york, urgent care
The reason you needed to go to urgent care is because you don’t have a primary physician yet. A primary-care doctor should have been able to make the same diagnosis. Data from previous records is actually really useful for diagnosing a chronic illness, and prescribing treatment that had previously worked. It was just fortunate that you actually knew enough of your personal history.
Primary physicians take too much time to make an appointment. If indeed the primary care person was going to make the same diagnosis, then I would prefer urgent care, barring the fact that it is more expensive. Please note that urgent care is not ER, so I am not crowding out critical patients. I would not use urgent care for a chronic illness, though you might argue that the recurrent nature of my situation may make it cross that line.
Also, why assume that a primary physician will read your medical history better than the urgent care guy? If it is just because he has a monopoly on your record and is the only person who has a copy, then that is a ridiculous advantage to give the guy. There is a familiarity bias in medical care – just because someone has your record and has seen you before does not make him more competent at treating you. Consistency and accuracy are two separate things.