Let's Rate Emergency Rooms (Pittsburgh: offices, health care, rated)

[Katarina Witt]

Originally Posted by greg42

Oh yeah, certainly there are times when what may seem like ordinary office visit-type things must end up at the ER because the office is closed or such. The person I'm talking about simply doesn't do any well visits or anything despite having the insurance. It's one thing for yourself, but I don't get it for the kid. I don't have kids, but even I know there's a bunch of well visits for them to do when young, and the kid was a major preemie to boot. Wonder why? Maybe lack of prenatal care?

Most docs have some sort of after-hours service where you call the office # and get the dr. on call. If s/he thinks you need to be seen before the office re-opens, there will be some protocol. Either s/he will tell you to go to urgent care, or meet you in the office. If it's a true emergency, s/he will send you to the ER.

[Hopes]

Originally Posted by Katiana

Most docs have some sort of after-hours service where you call the office # and get the dr. on call. If s/he thinks you need to be seen before the office re-opens, there will be some protocol. Either s/he will tell you to go to urgent care, or meet you in the office. If it's a true emergency, s/he will send you to the ER.

They rotate being on-call with other doctors in the practice, but they only talk to you on the phone. If I need to be seen, they have always sent me to the emergency room when the office is closed. There aren't many urgent care places around Pittsburgh. I've never been told to go to anything but the emergency room. I've never had a doctor go into the office when it's closed either.

When I don't need to be seen in an emergency room, they call medication into the pharmacy, but I guess I am just lucky because people tell me that it's illegal for doctors to prescribe medication without seeing a patient. If they're not charging the insurance company for an office visit, it doesn't seem like breaking the law to me. Every doctor I've ever had for myself and my family members have called in prescriptions---they still do.

Maybe you can tell me if that's true that it's illegal to do since you're a nurse.

[Katarina Witt]

Originally Posted by Hopes

They rotate being on-call with other doctors in the practice, but they only talk to you on the phone. If I need to be seen, they have always sent me to the emergency room when the office is closed. There aren't many urgent care places around Pittsburgh. I've never been told to go to anything but the emergency room. I've never had a doctor go into the office when it's closed either.

When I don't need to be seen in an emergency room, they call medication into the pharmacy, but I guess I am just lucky because people tell me that it's illegal for doctors to prescribe medication without seeing a patient. If they're not charging the insurance company for an office visit, it doesn't seem like breaking the law to me. Every doctor I've ever had for myself and my family members have called in prescriptions---they still do.

Maybe you can tell me if that's true that it's illegal to do since you're a nurse.

I'm not familiar with the laws of Pennsylvania, but I don't think, based on my own family there, that it's illegal. Docs don't usually like to do it (prescribe w/o seeing the pt) b/c they don't really know what's wrong with the pt. I do telephone triage and I have seen many a misdiagnosis by parent. I know our docs are more likely to prescribe by phone if the pt has had similar symptoms in the past that were helped by a specific med, or if the pt. is requesting a refill of a current med.

[Hopes]

Originally Posted by Katiana

I know our docs are more likely to prescribe by phone if the pt has had similar symptoms in the past that were helped by a specific med, or if the pt. is requesting a refill of a current med.

That's usually the case for my family when medication is prescribed over the phone. We each tend to have different recurrent illnesses specific to each of us. It also helps that we have long standing relationships with our doctors. I've been seeing mine for 25 years. He knows my medical history in his head. If it can't be addressed over the phone, we always get sent to the ER. Insurance doesn't even require a primary care approval anymore, nor notification, so I'm sure that people are goinig to start using the ERs even more than before. I personally would prefer treatment over the phone when possible because I hate the ER, but sadly some things need a physical evaluation. Maybe in the future there will be virtual healthcare where the doctor can look at patients through a computer screen. One can only dream....

[Bong477]

Originally Posted by Hopes

They rotate being on-call with other doctors in the practice, but they only talk to you on the phone. If I need to be seen, they have always sent me to the emergency room when the office is closed. There aren't many urgent care places around Pittsburgh. I've never been told to go to anything but the emergency room. I've never had a doctor go into the office when it's closed either.

When I don't need to be seen in an emergency room, they call medication into the pharmacy, but I guess I am just lucky because people tell me that it's illegal for doctors to prescribe medication without seeing a patient. If they're not charging the insurance company for an office visit, it doesn't seem like breaking the law to me. Every doctor I've ever had for myself and my family members have called in prescriptions---they still do.

Maybe you can tell me if that's true that it's illegal to do since you're a nurse.

I'm a physician. Its not illegal. There must be a doctor/patient relationship to prescribe someone medication. Exactly what that means is open somewhat to interpretation, but generally means you have to be an active patient in that practice.

[Hopes]

Originally Posted by Bong477

I'm a physician. Its not illegal. There must be a doctor/patient relationship to prescribe someone medication. Exactly what that means is open somewhat to interpretation, but generally means you have to be an active patient in that practice.

Thanks for letting me know I wasn't crazy!

I was surprised when I had an ER nurse tell me it was illegal.

We were just shooting the breeze about different practices we liked.

Somehow the topic of calling in prescriptions came up and she said it was illegal.

Totally blew me away!

[greg42]

Urgent care was a little slow here but is spreading rapidly. Even ignoring the doctorless in-store clinics at CVS, Walgreens, Walmart, etc. (which in some ways do count as urgent care) you have MedExpress with several locations now surrounding the city, Heritage Valley (Sewickley and Beaver hospital group) has one or two and is opening more, UPMC itself is opening one in Shadyside (so is MedExpress, heh, competition is good I suppose) and I believe already opened one in East Liberty. It's clearly a model that makes sense, something that's not quite an ER but can treat minor non-threatening conditions quickly with no appointment.

When the doctors get used to the newfangled stuff they'll get more into recommending urgent care in certain situations, but it takes a while to get out of the set ways. (Hey, up until about maybe 2 years ago there really wasn't another choice in the Pittsburgh area.)

[Hopes]

Originally Posted by greg42

When the doctors get used to the newfangled stuff they'll get more into recommending urgent care in certain situations, but it takes a while to get out of the set ways. (Hey, up until about maybe 2 years ago there really wasn't another choice in the Pittsburgh area.)

It seems that the ERs think urgent care is taking business away from them. I had an ER nurse practitioner complain that many people who go to MedExpress end up in the ER shortly afterwards, and he told me that I shouldn't ever bother going to MedExpress. I thought that was strange because I thought ERs wanted people to go elsewhere whenever possible.

[greg42]

Originally Posted by Hopes

It seems that the ERs think urgent care is taking business away from them. I had an ER nurse practitioner complain that many people who go to MedExpress end up in the ER shortly afterwards, and he told me that I shouldn't ever bother going to MedExpress. I thought that was strange because I thought ERs wanted people to go elsewhere whenever possible.

Well it's clear that the hospital groups don't necessarily want to lose these types of patients to an outside company. Otherwise they wouldn't be working to open their own urgent care clinics. It's true that the urgent care can't handle everything, but if you familiarize yourself with what these different places can and can't do (or call first, etc) you can save yourself that possibility of going to urgent care only to be told to go to the ER. For example, my problem back at Thanksgiving, hm, well, I didn't really have another handy choice up there, but I think I would have gone directly to ER at any rate. But in general I think I'd rather avoid the ER, even the best ones, for something that seems minor. I mean, if I have some kind of infection right now (sore throat, coughing, everything points to viral so I'm not looking to go anywhere) I can't imagine going to the ER this weekend for that.

It's interesting. Based on my two recent ER experiences (one as patient, one not), I would conclude that ERs are very busy on Saturdays and not so much on weekdays during the day. Does anyone else find this to be true? Not sure we have a big enough sample.

[Katarina Witt]

Originally Posted by Hopes

It seems that the ERs think urgent care is taking business away from them. I had an ER nurse practitioner complain that many people who go to MedExpress end up in the ER shortly afterwards, and he told me that I shouldn't ever bother going to MedExpress. I thought that was strange because I thought ERs wanted people to go elsewhere whenever possible.

I don't know if it's the ERs that want people to go elsewhere. The insurance companies would prefer you go elsewhere, and the "health planners" prefer that, too. There's this big emphasis these days on a "medical home", which means a relationship with your own health care provider. You're supposed to call them in the evening and on weekends.

I do get discouraged when, on a Monday moring, a patient says to me, "I knew you weren't open on weekends to I took her (him) to the ER, and he had a viral sore throat." We have a call system, and we do see people in the office on the weekends. Also, sometimes a call will eliminate the need for the visit in the first place.