Mad Medicine Alert: How Urgent Care Clinics Mess You Up
by Janice M. Horowitz
A former Time Magazine health reporter reveals the hidden forces at work every time you go to the doctor — and tells you when to raise the red flag to get the best care possible
Medicine isn’t pure. Every time you sit in a doctor’s office, there’s something going on behind the scenes that you probably sense, but you can’t quite put your finger on. And you’re too preoccupied with what ails you to give it much thought anyway. I’m not talking about what you suspect: insurance companies or drug makers. This is much more fundamental. With Mad Medicine Alert, I explain what’s really going on when you’re at the doctor’s so next time you have a medical problem, you’ll know exactly what to look out for. You’re going to become one smart health consumer.
Today’s Alert: Urgent Care Clinics
Who doesn’t love urgent care centers? Excellent in a pinch, they’re just up the block or around the corner. Brightly lit, modern and with friendly staffs, they’re veritable shrines to good health. There are nearly 10,000 of them nationwide and doing quite well, thank you, raking in a total of nearly $15 billion each year. But with all their success and image of medicine at its best, there’s something you don’t know.
An urgent care’s doctor’s salary, schedule and ranking at the clinic depend on the ratings he receives from none other than the likes of you. The doctors at urgent care clinics live for your feedback and securing your five stars on a survey is their goal. You may be a smart and concerned patient, but you’re also someone who’s never gone to medical school, has zero clinical experience and yet, and this is the strange part, you hold sway over your doctor. And that can be dangerous to your health.
I know from my own experience. Recently my eleven-year-old daughter had an earache that was so bad that even as a tween, she was wailing. It was six in the evening on a Sunday and there was no way was our pediatrician open. But urgent care, right up the block, was and humming with activity.
We walked in, filled out the forms and waited. As soon as we saw the doctor, he said he was going to “cure” my daughter. This would be the first red flag that something’s amiss. You should always get nervous when doctors talk about cure. It’s one of the hyperbolic words that suggest your doctor isn’t thinking so hard about your case. What if my daughter had an anatomical problem that caused her earache? He couldn’t cure that without performing surgery on the spot. What if she had an autoimmune problem that made her prone to infection? Would he rid her of that one evening? So, here’s a rule: get worried when a doctor talks about a cure.
Here’s what else happened. He looked in my daughter’s ear and told her that he would make her “feel all better.’’ He went onto to prescribe a bevy of pills so large that they could make a foldout couch open. He dispensed a triple dose of extra-strength Tylenol to “get the pain down fast,” and advised a double dose of Advil two hours later, instead of the usual four to six hours, followed by more Tylenol two hours after that. These near back-to-back, high doses of two different types of painkillers, bound to tax anyone’s liver, let alone a teens, are similar to what’s given to post-surgical patients. But he wanted my daughter to leave urgent care without an iota of pain. He wanted her — and me — to feel happy. Here’s another rule: don’t bombard your system. Whenever you can, try the lowest dose of a medicine that appears to work.
The doctor didn’t stop at painkillers. I mentioned that we were going on vacation the next day, so, eager to please The Mom and secure a favorable review, he doled out a prescription for antibiotics. What the doctor surely knew is that antibiotics usually don’t do a thing for earaches, but he thought I was anxious to do something, anything to resolve the earache in a hurry, so at least it looked like he was being accommodating. Even if it wouldn’t make a difference. Given my health background, I told him his approach was completely wrong. (He lost his good rating right then and there) The American Academy of Pediatrics only advises antibiotics for earaches that have been going on for at least three days. My daughter’s was merely a few hours old.
The lesson here is never take antibiotics willy-nilly. Always question the doctor when he writes an Rx for them. And if you sincerely need them, then here too, ask if you can have the lowest possible dose
Most earaches resolve on their own since they are caused by viruses, not bacteria. And viruses are not vanquished with antibiotics. When antibiotics are used unnecessarily, you risk developing resistance to them for genuine infections down the line. And overprescribing antibiotics fuels the rise of “superbugs” — germs that grow ever stronger in their quest to fend off antibiotics, until they win and repulse each new generation of germ fighters.
In this case, the urgent care doctor’s interest in a satisfied patient — whose pain was guaranteed to disappear quickly and who was given pills just to show he was doing something to address a mother’s concern about vacation — ruled. Money-driven decisions at urgent care centers such as these occur with more than just earaches. And they nearly always lead to over diagnosis and overtreatment. You can wind up over treated with antibiotics for the flu, with narcotics for simple pain and with inhalers at the first sign of seasonal allergies. What’s more, doctors who are worried about their rating will also demur from discussing uncomfortable but important topics like obesity and smoking cessation. All in the name of patient satisfaction.
How did this come about? One of the first acts of Obama Care, back when the controversy over the Affordable Care Act seemed positively civlized, was to reduce Medicare reimbursements to hospitals given poor marks by patients for waiting times, doctor communication skills and other measures of a patient’s experience. Fair enough, but the focus on this type of patient satisfaction has led to a proliferation of online surveys, not just in hospitals but in all manner of medical centers, including those ubiquitous urgent care facilities. In fact, an entire industry has sprung up around providing these surveys, something that nearly always helps perpetuate the status quo. The company that has the most to gain from surveys is Press Ganey, a rarely heard of firm based in South Bend Indiana that is now the nation’s leading provider of medical surveys; they also help link a physicians salary to how well patients rank them.
A recent survey underscores how this Yelp approach to medicine can harm you. The South Carolina Medical Association found that 55% of its doctors said they had ordered an unnecessary test because of patient pressure and nearly half had improperly prescribed medicines out of concern for a patient satisfaction survey. Another study in the Archives of Internal Medicine found that patients who gave the highest satisfaction scores to hospitals and doctors were 26% more likely to die than those who gave the lowest — likely because they wound up over tested, which led to overtreatment and all the while, they were under counseled.
In the case of my daughter, I took her home and gave her one Tylenol for pain. She slept pain-free and woke up the next day earache-free too.