As the role of urgent care clinicians continues to expand in the house of medicine and we take on more responsibilities, it’s our job as clinicians to ask ourselves:
How can we be better?
How can we do better?
How can we treat patients better?
In other words, how can we be great urgent care clinicians?
To answer these questions, we have to start by understanding the unique challenges of working in urgent care. The answer to what makes a great urgent care clinician comes from understanding how to overcome these challenges.
Multiple Hats
If you’ve worked a day in urgent care, you know it’s a constant juggling of different hats.
There are times when you have to put on your emergency medicine hat and think from an acute care mindset to determine if the patient needs a higher level of care. Then there are times when you have to switch gears and put on your primary care hat to bridge between urgent care and primary care follow-up. As if that isn’t enough, urgent care clinicians also have to take on various specialist roles when follow-up appointments for patients are hard to come by.
Juggling all of these hats can be hard on even the most seasoned urgent care clinicians. And mastering any of them is even harder to do when working in a fast-paced setting.
Limited Resources
Many urgent care centers are resource-limited, especially in comparison to emergency departments. While x-ray capability, point of care respiratory viral and strep testing, and phlebotomy services are standard, other tests or supplies can be lacking in urgent care centers. This makes caring for certain patients or medical conditions challenging.
With this information in mind, what can we do to become great urgent care clinicians?
- Become an (evidence-based) MacGyver: Limited resources are no problem when you’re armed with evidence-based alternative approaches to certain procedures or medical conditions.
For example, imagine you need to get a urine sample from a feverish infant to evaluate for a possible UTI. If your center doesn’t stock pediatric straight catheters, you can try the Quick Wee method or the Bladder Stimulation Technique to collect a clean catch urine. Evaluating a patient with chest pain but don’t have a point of care troponin? Use the HEAR score to risk stratify patients that need a higher level of care. - Master your juggling skills: Sharp clinical reasoning skills can help you switch from one hat to the next. Use your emergency medicine hat to determine the “worst first.” Once emergent issues have been considered and acted upon, your primary care hat can help determine the next steps in the longer-term management of the patient.
Severely elevated blood pressure is a great example of how a clear clinical reasoning pathway comes in handy. When you see a patient with severely elevated blood pressure (≥ 160/110 mmHg), put on your emergency medicine hat and use your history and exam to determine if the patient is having any signs or symptoms of end organ dysfunction. If they are, refer them to the emergency department. If they're not, then you swap out your emergency medicine hat for your primary care hat and determine what that patient needs until they're seen in follow-up, whether it’s lifestyle modifications or starting an antihypertensive. - Stay up to date with the recent literature and guidelines: In order to become a MacGyver in the face of limited resources and to master your juggling skills, you need to stay up to date with the latest literature. Our unique place in the house of medicine requires us to be in the know about both emergency medicine and primary care literature… and everything in between!
In all honesty, this can feel overwhelming, but there are so many ways to stay informed. Listen to podcasts or subscribe to newsletters that help direct you to the most pertinent journal articles. You could even start a journal club at your work and talk about what you’re reading and listening to with your colleagues.
For more on this topic, listen in as Sarah Warren, Vicky Pittman, and Matthew DeLaney discuss “Going From Good to Great” in a special Urgent Care RAP podcast segment recorded live at the UCA conference! See our full chapter summary here.
