Hacker News Reader

Comment by tptacek | Hacker News Reader

Like a lot of people, I exclusively go to urgent care for routine stuff, and for the first line of care for anything more serious, and I have never once had the experience of being bounced to an ER. They share records with my PCP but can see me at the drop of a hat on no notice.

People overuse doctors. Most of what younger people (under, say, 50) go to the doctor for, a good NP can do just as well or better. One of my weird hobbyhorses is how dumb the name "nurse practitioner" is; they should just call them "associate physicians".

(Note here that we're talking about "urgent care", which are clinics run by health chains, staffed with a doctor or two, a couple NPs, and a bunch of nurses; "urgent care" is not the ER, which is a thing people gotten hung up on HN about before, because I guess every country calls their ER something different. Going to the ER for routine care is insane.)

View on HN

I've been "bounced to the ER" once, but that's because the x-rays showed pneumonia, and my vitals were... not in a great spot.

Even then it was phrased as more "If it were me, and I had similar comorbidities, I'd get that looked at ASAP"

Ended up hospitalized for 4 days.

>One of my weird hobbyhorses is how dumb the name "nurse practitioner" is; they should just call them "associate physicians".

Well, there are "physician assistants", PAs, which are the same rung of the ladder as NP but via different path. Areas tend to somehow converge either on NPs or PAs, but not both so often.

Your experience and my experience vary a lot.

My background is CA & NYC. I am able to get same day or same week (if less urgent) appts by calling my primary (PCP). In the event that my PCP has no availability or it's late in the day, I'll consider going to urgent care since it's the only thing open.

I can understand other people posting how hard it is to find a good PCP (or even dentist frankly). I got lucky and found a good, local PCP that I've been seeing for years.

It is maybe a little bit crazy to design a system that charges people based partly on how well they are able to self-assess their need for care.

The ER and urgent care at my local hospital are next door to each other. Until the last year or so, it was the only urgent care in the area (and is the only ER).

The system I'm describing does no such thing. Urgent care is the doctor's office. It takes less self-assessment, not more, to go to urgent care, because you can go inexpensively and with no notice or appointment. Got a weird itchy bump? Stop in on your way back from work. If it's a rash, they'll tell you take Benadryl. If it's Fatal Familial Itchy-Bump-Itis, they'll square things away with your PCP and get serious diagnosis and care expedited.

It works extremely well with my doctor's health system, and I'll add that my doctor's health system is notorious in the area for sucking to work with, so if I switched to, like, Rush or Northwestern, presumably it'd be even better.

Why should that stop cost more of you walk in the other door?

One argument could be that treating non emergency cases would ruin availability or increase costs, both of which seems like big assumptions at a system design level (vs the actual constraints and incentives that have lead to the existing service configuration).

At the point where you're noticing that Urgent Care costs less than a primary care appointment and find that problematic, it really starts to feel like you're just searching for things to disagree about. It's OK if we run out of things to dispute!

I'm talking about the ER not having a triage level that is equivalent to urgent care, not comparing urgent care to primary care.

Lots of hospitals do have attached urgent care clinics.

Yeah, like I described in my first reply. Seek care at the wrong spot and you pay a lot more, for reasons that I don't think are particularly clear.

I'm sure that there are regulatory drivers, but I expect they are things we should seek (as a society) to improve, rather than accept and ignore.

ER is expensive because have to deal with life-and-death emergencies. They also have to deal with treating everyone.

Primary care is good for dealing with ongoing issues. It is cheaper because only staff what they need. But have to schedule appointments far out. They could leave slots open for urgent issues but then would cost more.

Urgent care is to handle the urgent but minor issues. Stuff that doctor could handle if they were open or had appointments. They are more expensive since they are open longer hours and less likely to get insurance.

One thing that would help fix the system is lots more free 24-hour urgent care clinics. That would keep people out of ER.

Associate physician would be a great term, but taking the analogy to the legal profession, wouldn’t we expect an associate doctor to become a doctor someday? Isn’t an associate doctor actually a resident or intern?

Agree NP is a poor term.

Reply on news.ycombinator.com