You’re sick. Now try to get in touch with your doctor

Time. Time. Time does not stand still.

In our community, someone has a sharp pain. Or an elevated fever. Or intense nausea. So he picks up the phone and calls his doctor’s number.

If, for example, he phones his doctor’s number at Park Nicollet or Allina/Abbott clinics, his call is received at a “call center” somewhere in cyberspace — not at the clinic that houses his doctor’s office. Then begins possibly a long wait, and next his journey through several phone trees with possibly more waits.

Part of a comment on Park Nicollet’s comment page reads:

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“On 10/3/21, I just wanted to speak to someone about my blood pressure. I tried a virtual visit, and the appointment times were to[o]far out. I called the appointment line.

“3 times it said there were to[o]many calls and to try later. I finally get on the line and the call would be answered in the order it was received. I suppose I could have left a number and they would have called back. I didn’t feel well and thought I would stay on the line. 45 minutes later my call was answered and I was transferred to a nurse.” (park-nicollet.pissedconsumer.com)

Michelle Olson, operations director of Park Nicollet Health Services for Primary Clinics, answered many of EPLN’s questions in a recent phone interview. Olson was accompanied in the interview by Tasha Gastony, Park Nicollet South Region medical director.

The Park Nicollet administrators note that a patient phoning should request the nurse triage line. Olson and Gastony note that a caller mentioning specific symptoms should be answered within 24 hours by the nurse triage, while a more general call might be answered within five days.

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(An EPLN call to a Park Nicollet call center found that there is no mention of a nurse triage line. The person fielding the EPLN call said that a patient had to specifically request the nurse triage line to get connected to it.)

Forget the phone

Olson and Gastony recommend that a potential patient NOT phone the doctor/clinic’s number. Instead, ahead of any medical problems, they should create an account on the internet patient portal provided by their clinic (such as MyChart) and complete all necessary details. When a medical issue arises, they should use their internet account to contact their specific healthcare provider. This approach offers the additional advantage of making their medical history immediately available to the provider and describing their symptoms.

Apparently, efficient treatment hinges somewhat on how comfortable a patient is online.

When seeking medication, the Park Nicollet administrators say that you should always initiate a request for a prescription refill with your pharmacy. If you are seeking a renewal of an expired prescription, you can request your internet account. If the prescription expires within 15 months of your request for its renewal, the renewed prescription should be available to you in three to four days.

Per Olson and Gastony, a virtual meeting with a physician using telehealth is always possible on the same day or the next. If a patient prefers an in-person meeting with a specific physician, that can occur within three to five weeks.

The Park Nicollet administrators point out that during the COVID-19 pandemic, there was a 300% increase in online requests for medical care. Therefore, clinics need to prioritize their attention to these requests.

Since the heavy demands of the pandemic, Olson and Gastony have observed that some doctors and nurses have left their professions.

Emergency care

Dr. Amy Irvin is an emergency room physician at St. Francis Regional Medical Center in Shakopee. She notes that in the wake of the COVID-19 pandemic, more patients and fewer medical resources are available.

Since there are fewer and fewer open hospital beds, Irvin said emergency rooms have been forced to “board” patients in the examining rooms. In the past, such patients would typically be transferred to hospital beds. When emergency room exam rooms and nurses are occupied by boarders, she said emergency care is delayed.

Between the clinic and the emergency room, there is the middle ground of urgent care.

Olson and Gastony say that depending on the time of day and the day of the week, urgent care can respond in 20 minutes up to three or four hours.

Typically, patients walk into urgent care. But, Olson and Gastony said Park Nicollet now has a “save my spot” feature that permits patients to call and obtain a time to come in for urgent care. However, when the number of save-my-spot callers ratchets up, the feature is turned off. Olson and Gastony say there are long waits in urgent care, early in the morning and the evening.

In emergency rooms, wait times are governed by the triage nurse, who assesses each patient upon arrival. Irvin said patients can spend 30 minutes to half a day in the emergency room before their case is resolved. However, some patients may request additional tests simply because they are in the emergency room and have taken time off for the visit. Irvin warns that this desire for a comprehensive workup can verge on over-testing and may divert attention from other patients.

Dr. David Dvorak, an emergency room doctor for over 30 years, now works as a primary doctor at Northpoint Health and Wellness Center, a community clinic in North Minneapolis.

Dvorak, too, complains about having to “board” hospital patients in emergency room examination rooms. He also says clinics sometimes unnecessarily send their patients to emergency rooms — “not a good use of medical resources.” He notes that the triage nurse prioritizes chest pain, shortness of breath, and stroke symptoms.

A hardened veteran of medical care, Dvorak notes that there is no continuity in care. Dvorak said that a fragmented, “multi-payer” medical system creates insurance obstacles that make it difficult to refer a patient from the emergency room to a specialized physician or another source of care.

Nevertheless, Dvorak notes that patient satisfaction forms can give patients a voice in receiving quality treatment and that hospitals receiving Medicare payments are evaluated based on patient satisfaction scores. He also noted that insurance companies often offer nurse triage phone lines to help facilitate medical care.

Irvin does make a positive observation about her work as an emergency room physician. She explained that by the end of her shift, she must put a treatment plan in place for every patient she has seen, which helps to limit each patient’s treatment time.

What to do? What to do?

Within the realm of clinic, urgent care, and emergency procedures, there is often a grueling tension between addressing the patient’s immediate pain and the institution’s need to prioritize care.

The patient does have to remember that he is a medical consumer. He does have the power to change his insurance, his clinic, or his doctor.

If the tips in this article do not help adequately, and if the COVID-inspired flocking to doctors seems overwhelming, there may be something more you can do.

The trend to consolidate medical practices into huge clinics has existed for years.

In a June 9, 2021, article titled “Pros and Cons of Small Practices and Large Health Systems” on Physicians Thrive, Justin Nabity wrote: “First and foremost, consolidation into larger health systems allows those systems to eat up a larger share of the market profit.” The benefits for the patient are a lot of doctors and medical talent, more types of exotic medical equipment, and more laboratories. The disadvantage is having to navigate a large, complex medical system.

We speak of banks that are too big to fail. Perhaps in medicine, a clinic can become too big to succeed.

On a computer at home or at the public library, you can search for “clinic.” Such a search can permit you to locate local “small independent practices” (SIPs). If some are outliers of large clinic systems, all the better. If they seem to make health care more accessible, interview them. You may find a new medical home. Good luck.  

Reporter’s note: My Eden Prairie Local News colleague Vijay Dixit introduced me to Dr. Amy Irvin, and my colleague Jeff Strate introduced me to Dr. David Dvorak.