As 2022 ends, I have a sense of déjà vu. Once again, we are facing high patient volumes across Urgent Care centers due to an early and severe influenza season as well as outbreaks of other upper respiratory infections including RSV and COVID-19. We know this is true not only from our experience, but CDC data confirming the trend.
Providers and Urgent Care staff are overwhelmed, tired and facing burnout. Our waiting rooms are consistently full of patients who feel sick and demand immediate relief. The day is unrelenting, mental fatigue sets in after the 20th patient with “flu-like symptoms,” and the onslaught does not stop.
Hang in there. We are all in this together and the College of Urgent Care Medicine is here for you. Reach out to a colleague and fellow member and ask how they are doing. It is therapeutic to hear from colleagues and to know that we are not alone!
In case you missed it, November 18-24 was Antibiotic Awareness Week. Through the efforts of public health agencies and the Urgent Care industry, we have made significant progress on educating the public on appropriate antibiotic use. As a result of this effort, most patients recognize that antibiotics are ineffective against viral upper respiratory infections. Yet, we still have patients that demand their “Z-packs” for their flu-like illness, cold, or even COVID. During busy times, it is easy for the provider to give in to patient demands.
A number of callbacks are complaints, including, “The antibiotic didn’t work,” and “I want a stronger antibiotic.” When I ask the provider why they prescribed the antibiotic I will usually get the answer of, “I was too exhausted to fight with the patient,” “I didn’t want a complaint on social media,” or that there is anxiety over “satisfaction scores.”
It is easy to say no to a patient when they demand a controlled substance but harder to say no when they demand an antibiotic. We often forget that antibiotics are not benign medications, and the risks and percentage of patients who develop side effects are significant. I tell my viral URI patients, “Unfortunately you have a viral upper respiratory infection, and antibiotics will not make you better faster. Let’s talk about what you can do to make you feel better.” Most patients will respond, “I thought so but I wanted to make sure I didn’t have anything serious.” We are getting the message across. Patients want explanations, and the time you spend with the patient translates to higher patient satisfaction.
When waiting rooms are full and every patient seems to complain of “flu-like symptoms” it is easy to get complacent. Early signs of flu and COVID-19 are non-specific. Last week, a colleague presented a case where a patient reportedly had flu but ended up having diverticulitis. The patient reported direct flu exposure, fever, chills, nausea, vomiting and cough. The antigen flu test was negative, but the patient was started on oseltamivir for a clinical diagnosis of flu. Fortunately, the patient returned the next day with increased abdominal pain and was promptly diagnosed with diverticulitis. I appreciated the reminder to be cautious, especially when someone does not present with significant upper respiratory symptoms. In my career I have seen early presentations of rickettsia spotted fever, pyelonephritis, necrotizing fasciitis and appendicitis all masquerade as “flu.” Don’t be fooled.
In close, I’d like to wish everyone a happy holiday season. Stay well, and I look forward to the New Year, including seeing you at the Urgent Care Convention in Las Vegas (March 31-April 5). Mark your calendars now and ask for that time off!
Chris Chao, MD
President, College of Urgent Care Medicine Board of Directors