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Part of the work we do in urgent care is providing screenings, assessments and physical exams for particular purposes where no physician-patient relationship exists, such as for pre-placement or other work-related exams. Invariably, though, some of these folks are going to ask you for…

Can you just refill my ______ (blood pressure, gout, whatever) prescription?
Can you give a cream for this rash?
I’ve got a little cold, can you prescribe an antibiotic?

Or any other unrelated, private medical problem
The wrong way to handle this situation is to go ahead and diagnose and prescribe something, because now you’ve created a physician-patient relationship, you are obligated to follow up on the problem, there is resultant malpractice liability, and usually have done so on your client company’s dime.
There are two ways to handle this correctly. The first is sort of a hard-line approach to just have a policy that keeps these patients completely separate in your practice–if they are here for a DOT or work-related problem, you cannot treat them for a private medical problem.
The second way, and what I prefer, since I always like to treat patients in as positive a manner as possible to is reply, “Well, Mr Jones, I’d be happy to take care of that for you. However, I just need for you to check in as a private patient, since you are here for a work-related problem today, and we need to keep your diagnoses, treatment, and medical records confidential and separate from your work related records. If you just wait here a moment, I’ll have the receptionist get the right paperwork and insurance information from you.”
This establishes several important points for your practice as well as for the patient:

  1. Maintains confidentiality of private medical conditions from employer
  2. Welcomes work related patients in to the urgent care/general medical side of the practice
  3. Establishes correct physician-patient relationships
  4. Lets patients know that they are financially responsible for any treatment of their private medical problems 

Once you’ve established this in the patient’s mind, sometimes they’ll realize, oh this is more than just an “oh-by-the-way-doc” encounter and decide to wait and go see their regular physician, and other times they’ll check in and you can go ahead and take of them just as you would any other patient in your urgent care center.
Part of your internal marketing for your practice should certainly be to invite any work-related patients to become urgent care/ private patients.  But keep it in context and you’ll avoid potential conflicts among your clients, patients, and staff.

How do you handle “Oh-by-the-way-doc….” in your practice?

 
 

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