Participants: Dr. James Marcum (Host), Paula Mille C.N.P.
Series Code: BRX
Program Code: BRX00024B
00:01 Welcome back to Bible Rx, we are talking today with Paula
00:04 Miller about all sorts of interesting health care issues.
00:08 Paula before the break we were talking about Urgent Care
00:11 Centers, we were talking about when they might be used.
00:14 One question that came to my mind is expense.
00:17 As an Urgent Care Center in general more expensive
00:21 then an Emergency Room?
00:22 No, an Emergency Room is much more expensive.
00:26 Urgent Care is going to be 50% or less than what an
00:30 Emergency Room costs are going to be.
00:32 On a general basis Urgent Care Center is about the same
00:37 cost as going to a primary care physician as the base
00:42 price goes in the fees will accrue according to what you
00:46 have to have done, being it x- rays or lab and things like
00:51 that, but it is much less cost than an Emergency Room.
00:55 What about the hours, our Urgent Care 8 to 5, 8 to 12
00:58 are they open on weekends, did they stay open at night
01:01 when I get off work?
01:02 Most Urgent Care are open seven days a week.
01:04 The one I particularly work with is, the hours are very
01:08 convenient for most people.
01:10 Most of our hours are 9 to 9, so we are open 12 hours
01:15 open longer than most offices to provide extended care
01:20 to people that are working 8-5 or 9-5 and they can't
01:24 get it to see their primary care physician so
01:26 we are open later in the evening for that convenience.
01:29 Now wait times, no one likes to wait.
01:32 No one likes to wait in an Emergency Room, I had a patient
01:34 the other day who had waited for hours to be seen.
01:36 Then they said he just had chest pain from a muscle and
01:38 he went home, they were mad because they were charged
01:41 like 500 - $600 just for that visit.
01:43 How, un-injured you never know, how long do people have to wait
01:48 to see a Nurse Practitioner?
01:49 Well that is a very difficult question to answer.
01:53 The Emergency Room is going to be much longer.
01:56 We try to get our patients in and out very quickly and it
01:59 depends on the flow too because if you had 10 people
02:03 walked through the door all at one time your waiting may
02:06 be a little bit longer.
02:07 But we generally get people in and out within an hour,
02:10 and commonly I have people comment that even though
02:13 we do not take appointments, that sometimes the wait
02:16 can be long, it is usually much shorter than going to
02:20 the physician's office with an appointment.
02:22 Now to Urgent Care only treat adults, or do
02:25 they also treat children?
02:27 No most of them treat all ages, our particular facility
02:31 does treat all ages.
02:32 Now 1 and under they do ask the provider that is there
02:36 how they feel to treat an infant,
02:41 but most of them treat all ages. It sounds like good information.
02:46 So it sounds like to me and Urgent Care center,
02:48 if we are educated about what type of problem, health
02:51 care problem we have the real advantage is wait time, hours
02:54 or more convenient and it also might be
02:57 less expensive on the system.
02:58 Great, the next question comes from the great state of
03:01 California and it is:
03:06 I guess this person wants to know in a Nurse
03:09 Practitioner's office what are some common problems
03:11 you see, for instance last week what were you seeing
03:14 in the office last week?
03:15 Okay, we think a lot of what we see as what time of
03:19 year it is, this time of year being winter we see a lot
03:23 of colds and flu's and bronchitis, sinusitis, upper
03:27 respiratory infections seem to be very common.
03:30 In the spring we see a lot of seasonal allergies
03:33 and the treatments of that.
03:34 Summertime a lot of sport injuries,
03:37 sprains, lacerations, things of that nature, and also treating
03:42 a lot of skin rashes, poison ivy, poison oak
03:45 and things like that.
03:46 The fall again that is when the flu starts coming around
03:50 again and that is the typical workload.
03:53 In the midst of all that you see a lot of your chronic
03:58 health conditions and we treat a lot of hypertension and we
04:02 deal with diabetes management, thyroid management.
04:05 What if somebody runs out of their medicine on the
04:08 weekend, and since I do not have enough medicine to make
04:10 it through till Monday, you probably wouldn't
04:12 get that would you?
04:13 Yes we do, that is a common thing that we see also.
04:16 Now for instance, sometimes I guess you might have
04:20 people out there that are worrywarts.
04:21 Let's say you get someone who's never had a headache
04:24 and you need to sort of see people you need reassure
04:26 that there is nothing serious wrong, and you have
04:29 a headache and it is okay.
04:30 Yes absolutely and sometimes just coming to someone that
04:33 will do an examination and give them the reassurance that
04:37 everything is okay and again to assessing them enough
04:40 to know if it is anything serious that we might may do
04:43 further testing on.
04:45 You know Paula a lot that I have seen here, and that is
04:47 part of what we do at Bible Rx is a lot of people
04:49 aren't educated on health care.
04:51 They get their news from the Internet or media and
04:55 sometimes that is not correct.
04:56 I have numerous patients they just need the assurance that
04:59 this is okay and it is nothing serious and being told what
05:02 to do, they don't know what's wrong in the middle of the
05:04 night and they don't feel good and they can't breathe and
05:06 they want to know whether it is a serious problem or not.
05:08 It sounds like Urgent Care Centers do that.
05:10 Yes we do.
05:12 No physical, you do all types of physicals?
05:15 Like sports physical, physicals for driving and
05:18 things of that nature?
05:19 Yes absolutely we do a lot of sports physicals and kids
05:22 that are starting to play basketball, soccer, football
05:26 and those type of things.
05:27 We also to a lot of Department of Transportation, DOT
05:31 physicals, these are the physicals that are required to
05:35 have a license a CDL license, a special license
05:37 to drive a commercial vehicle.
05:39 Now how about screening, for instance screening for
05:42 vision, someone doesn't think or aren't seeing well
05:45 and can't see an optometrist or ophthalmologist do you do
05:48 screening in vision and hearing and that sort of thing?
05:50 Yes they are basic screenings that would start the
05:55 process for vision, we use just a basic vision chart.
05:59 But this is what starts the process of saying they need to
06:02 go one further to an optometrist or an ophthalmologist.
06:05 Sounds like you give quite a few services and I'm going
06:08 to move on to another question here.
06:09 This question comes from Alabama and this person asks:
06:25 then they also ask if you do need to go to hospital
06:28 how is that handled? And then they want to know if
06:30 they were in an Urgent Care Center would
06:32 they get preference at the hospital?
06:33 Let's say you have triaged them would they have
06:35 to start all over?
06:36 It depends what their complaint is but what we have
06:40 done in the Urgent Care setting whether we have done lab work
06:44 an x-ray, or an EKG, and a copy of all of our records are
06:47 set with that patient took expedite their care.
06:51 Any further testing of course would be done at the
06:54 hospital depending on what their complaint is,
06:57 sometimes they have to go directly to the Emergency Room
07:00 for further evaluation.
07:02 We have a close relationship with a couple area hospitals
07:05 where we can directly call the hospitalist and communicate
07:09 with them what we have already found for them
07:11 to be a direct admission and again this just depends on
07:14 what their diagnosis is.
07:16 I'm sure some of our listeners are out there wondering
07:20 we are talking about a Nurse Practitioner, how's my
07:23 Doctor, my primary care Doctor I've seen for the last 10 or 15
07:26 years how are they going to feel about me by passing them?
07:29 I am sure that happens, we'll kind of response have you
07:32 had for the other providers when you see their patients
07:34 on the weekends or after hours?
07:36 Well some of them are favorable, some of them are not because
07:40 they are particular about their patients going anywhere
07:43 else, but some of them are very understanding and knowing
07:47 that they aren't available at the hours that are necessary
07:50 so they are kind enough to.
07:54 It seems like also communication between the different
07:59 providers is so important if you communicate.
08:01 If we treated this acutely and put you on this medication
08:05 but you need to make sure you get back to your primary
08:08 care provider next week to make sure there is no
08:11 interaction or that you are getting better.
08:13 As long as you do that, but you don't actually
08:15 try to steal patients.
08:16 No, absolutely not, and like I said previously we'd do
08:19 always his partners are routine care we document on
08:23 their chart and discard note making sure they follow up
08:26 be it with us or their primary care provider
08:29 because follow-up is always essential.
08:31 I'm sure people are asking out there what are some
08:34 the advantages, now a days in primary care you can get
08:37 your primary care solely from a Nurse Practitioner.
08:40 You can go to family medicine Doctor, What do you see as
08:43 the advantages of going to a Nurse Practitioner as
08:46 your sole source of primary care?
08:48 Well I am biased in the fact of knowing that Nurse
08:53 Practitioners do provide that little extra comfort
08:58 in a little extra TLC that some patients are looking for.
09:01 Now I do understand that not all patients prefer
09:04 Nurse Practitioners because they are not in an
09:07 Urgent Care setting.
09:08 You have patients and say they prefer to see a physician
09:11 and that is absolutely fine, but I do find that what
09:15 we provide sometimes is a little extra, a little extra
09:19 touch, a little extra education, just that little
09:22 extra that we got from our background as nurses.
09:26 Like for the patients it is much more convenient, you're not
09:29 taking away from their regular Doctor, you are meeting a
09:33 need that might not be met anywhere else.
09:35 Now on Bible Rx is really important that we talk about
09:39 the spiritual, the theme for program this year is at the
09:42 heart of health is love.
09:44 And I know sometimes time is limited and practitioners
09:47 can't always talk about their spirituality but just showing
09:50 them love and kindness and concern really does
09:53 show much more than speaking words.
09:55 How do you work in the spiritual side
09:57 in dealing with patients?
09:58 Do you just do by example, or do you wait for them to
10:01 open up, or how do you let them know who you serve?
10:04 Well I have had a few patients where you can pick up
10:08 that they are very spiritual and they are needy
10:10 that extra spiritual comfort.
10:12 I have had a few times to pray with a patient
10:16 an offer them the spiritual comfort that they need.
10:20 But I do find that the best way is to lead by example,
10:24 like you said, it just showing the compassionate
10:27 and comfort that they might not get
10:28 from everyday ordinary life.
10:30 Just the kindness, and I show a lot of my spirituality
10:35 through touch, I had always grown up in a compassionate
10:39 touch family and where that extra touch provided that
10:44 soothing comfort that was necessary.
10:46 You know I have found that the hardest people sometimes
10:49 take care of our ones that might be trying to take
10:52 advantage of you, or work the system so to speak.
10:55 How do you show love to someone who is coming in and you
10:58 know all they want is a pain medication, or they just want
11:00 a prescription for something you know in their heart they
11:02 don't need, how do you show love to that type of patient?
11:05 Well that it's very difficult Jim, I have found by
11:08 keeping a positive attitude and showing them love by not
11:13 being judgmental and trying to point out to them that
11:17 this narcotic pain medication, which is very common,
11:21 is not in their best interest.
11:23 It is not what is healthy for them and it is not
11:25 ultimately treating what they need.
11:28 I find that you showing a consistent kindness and
11:31 not turning a gruff shoulder to them and being
11:34 accusatory to them by showing kindness to them
11:37 is really the best practice.
11:39 You know sometimes I also see some people just take the
11:42 easiest way out and let me write them a prescription
11:44 here go on their way, I just don't!
11:46 I think it is much harder to educate and show compassion.
11:50 you know our time has zoomed by today and I hope our listeners
11:54 have learned a lot about what a Nurse Practitioner does.
11:57 That it is a good service and one thing I was impressed
12:01 with is the wait times, less expensive, the care you get
12:05 from the nurse with the practitioner.
12:07 Listener today if you might have questions or concerns
12:10 that we can answer please give us or send us an e-mail
12:14 at: heartwiseministries. org or you can write us at:
12:18 Heart Wise Ministries P.O. Box 8 Ooltewah, TN 37363
12:23 we would be happy to answer your questions and
12:25 I'm sure Paul Miller would get one of your question
12:28 she would answer, if you have questions about
12:29 what a Nurse Practitioner does.
12:31 And remember at the heart of health is love.