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27:
Healthy
Communities are Health Care Innovators
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Walk In: A Case Study
There is something wrong with our Health Care system, and it’s not just
shortages of staff, resources etc. It is also about how we do things.
I recently went though a health issue that involved three trips to Walk
In Clinics, 2 trips to the ER, 5 days with a catheter, and 2 trips to
the Outpatient Clinic. Not to mention a week of my life that I’ll never
get back.
I have a family doctor and I believe that if I had been able to get an
appointment with him within a reasonable time after symptoms appeared,
I could have avoided all that.
The real issue is what did that cost, in a system that is strapped for
resources? Why did that happen?
Prologue
I am one oI have those lucky ones who has a family doctor - the same
one for about 20 years. Most people did back then. When my previous
doctor retired I just selected another one from the same clinic. I took
having a family doctor as a given.
I’m very happy with his advice, the clarity of his explanations, and
his attention to detail. He is cautious.
**My Doctor works out of the Brandon Clinic conveniently located near
the Brandon Hospital, A Comprehensive Lab, and other related services.
As I proceed I will call it “My Clinic” to distinguish it from other
clinics that also play a role in this story.
I was a healthy guy. I’m 75. Never been in a hospital. I run, walk,
paddle and cross- country ski regularly.
A bout of prostatitis around that time was my first experience with a
bit of medical inconvenience and stress, but with time that faded -
except for a few mild relapses.
Over the next few years I would get a slight relapse - or more
correctly - a bladder infection that always brought some discomfort to
the prostate and area. Already by 2012 a shift in the whole meaning of
family doctor was underway - subtly at first. If I felt an infection
coming on I couldn’t get an appointment for several days, perhaps a few
weeks. That was no help at all, but My Clinic did have a reliable walk
in service. So I would use that. A dose of antibiotics was all I
needed. That was easy. Too easy. Soon some doctors were handing out a
prescription with no urine test. I just described my symptoms.
Sometime around 2018 my Doctor became concerned that my over-sized but
otherwise healthy prostate gland might become a problem by impeding
flow and making it difficult to empty my bladder. He carefully
explained
the serious consequences if that happened and the treatment options
that might be necessary to avoid serious consequences.
Just to be sure that I wasn’t in any immediate danger I was referred to
a Urologist for a Flow test and later, after a small issue with some
blood in my urine, for a complete scope of my urinary tract Very
entertaining. It didn’t explain the blood in the urine - but everything
seemed healthy, all was well for a time.
By 2023 I was used to periodic bladder infection symptoms, a bit of
burning, a bit of discomfort, frequent urination. I learned that with
lots of fluids and a good helping of cranberries they sometimes faded
without drugs. Getting up to pee a few times a night was just the new
normal.
In the first week of October I had a bout that I couldn’t shake.
And so
began my recent Adventure in Health Care.
Just to show how things have changed, I couldn’t get in to see my
Doctor for 5 weeks. I didn’t even bother. My Clinic used to also offer
a Walk-In service, but that was recently cut back - now registered
patients could still get Walk-In Service but space was limited - you
couldn’t always get in.
On October 5, I went to another clinic and received meds with just a
short explanation, no test.
Now, in my heart, I knew better. A year or two earlier after a similar
interaction with a walk-in Doctor, I was able to get a phone
appointment (Covid times) with my Doctor who sent me for a test and
reported that my urine showed no infection. The implication was that
something else was causing the symptoms with the culprit likely being
my over sized prostrate.
I explained this to the Walk-In Doctor but he believed that the burning
symptom indicated infection. Might as well try the meds.
I took the course of meds and things seemed to return to normal, but
after a week the symptoms returned.
On November 10, I visited yet another walk in doctor who agreed that my
enlarged prostate might need attention but said that in the meantime we
might as well check for infection. He prescribed meds and sent me for a
urine test, indicating he would let me know. In response to my concern
about the prostate, specially about the
danger of cancer, the Doctor said the prostate would be sensitive right
then and a PSA test would be a inaccurate.
I didn’t hear from him and assumed the test was negative. I finished
the meds, again, they worked temporarily.
An aside...LabWork.
I was used to waiting 2 or 3 three days to get lab results, so I was
surprised to learn that at some clinics simple urine tests were done on
site in a matter of minutes. Had that been standard practice a true
diagnosis in my case would could have been made at least six weeks
earlier. (Hint: that would have saved me a lot of trouble.)
I thought I was almost back to normal, then on November 19, the
symptoms came back - worse than ever. Late in the evening I went to
Emergency, and after a mercifully short wait a Doctor did a quick
Ultrasound - and showed me the problem - no surprise - my bladder
wasn’t emptying. They installed a temporary (five days) catheter to
quickly relieve the pressure, prescribed medication and sent me home.
What a relief!
I wish I could say my story ended there, but there had to be one more
twist.
Just over 30 hours after the catheter was in place, I found quite a bit
of blood in my urine. I checked with the instruction paper that I was
given upon discharge and it advised that I should consult medical
advice, perhaps via a phone call.
A helpful nurse suggested drinking lots of water and if it recurred the
next day see a doctor.
The water did clear it up, but it did recur again the next day.
So I called my Clinic on the off chance I could see someone, but by
that time all the walk in appointments for that day were taken. I
considered Emergency but decided to go to another clinic. It was about
noon. I was able to see a walk in doctor after about and hour and a
half. He tested my urine and seemed alarmed by a very slight fever and
told me I was in danger of infection and to go straight to Emergency
and have the catheter removed.
By 3 PM I was at the ER. It was obvious after a brief time with the
triage nurse that she wasn’t sure why I had been sent. She took my
vitals and said they were fine. It was clear that in the busy ER I
wouldn’t be a priority. I settled in for a wait. Four hours later I was
admitted to a bed. Four or five hours after that a Doctor saw me. Her
first question was something like “Tell me why you are here?” I
explained the process - had simply followed instructions. She had seen
my test results from the walk in and said I showed no infection. She
said she would scope me and do
bloodwork, and if all was clear I could go home. I said that would be
great, THANKS. A hour or so later this was done. She reported back that
all was clear. I went home an waited anxiously for my appointment to
get the catheter removed and get on with my life.
I asked about the blood and she said not to worry about it unless there
was clotting.
(And
looking back
some months later I have to report all went well.)
Just a
word here about the staff at our ER. They are amazing. When I
note problems and wait times, my concerns are about the system and the
staff shortages - not the individuals.
So what have I learned from this experience?
No matter how competent the walk in doctors are (and I believe they are
often great) they can’t have the perspective of my family doctor.
In the case I’ve outlined, my doctor and I have monitored my prostate
problem for years with the understanding that a time would come when we
might have to make a decision and take some actions.
I believe that if I had been able to get an appointment with my family
doctor in early October he would have instantly diagnosed my real
problem, prescribed the appropriate meds and solved my problem.
As it was, solving my problem seemed to involve an incredible waste of
resources. . There has to be a better way.
For example:
Right now the Doctors each take turns on Walk-In Duty. Once I went to
Walk In and got to see my Doctor. Bonus! On a recent trip to My Clinic
for a follow-up I was seeing a Walk-In Doctor while my Family Doctor
was seeing someone else just down the hallway.
Instead of that, what if each Doctor budgeted some free time each day
for their own patients instead of spending time each week with other
doctors’ patients?
Wouldn’t costs and earnings even out? Another thought.
It seems that the availability of walk in services has allowed us to
think we have accessible health care, when in fact Walk-In Service is
more like a Fast Food approach to Medicine. Just walk in and we’ll fix
you up. ( I mentioned my
experience getting meds).
Let me acknowledge that there are times a Walk In is OK and should be
encouraged. Times when patient history is irrelevant. Twice I have
received excellent care after being bitten by a dog, and after finding
a tick bite that could have led to Lyme disease.
LIke fast food, sometimes you just nee a quick fix.
In fact I remember when Walk-In Service was something new - available
as it was on weekend and after hours it helped take the stress of of
the ER.
Another aspect we should consider is that reliance on Walk-In Service
tends to make health care episodic as opposed to ongoing. I wonder what
is it like for a Doctor to see a patient, prescribe a med, and never
know how things turned out? To not be part of any sort of ongoing case
management?
What I received in the my ordeal was not “Care”, merely action. Not one
of the health professionals that helped me was involved in any
follow-through. My health crisis was a series of episodes.
There are alternatives. Cooperative and Collaborative models have are
available. But even within the current systems access to a family
doctor would have lead to a much better outcome and would have save the
system a great deal of money.
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