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“I Was Almost Stung by a Bee” and Others Not Belonging in an ED

by John Shufeldt, MD, JD, MBA, FACEP

Just about 20 years ago I opened my first urgent care center in Phoenix, Arizona. After four years in hospital Emergency Departments (EDs), I was ready and motivated to care for patients I had once treated in the ED, those who had come in with non-life threatening illnesses and complaints. This line of medical care delivery wasn’t part of my plan when I started out.

I had been trained at the best emergency medicine residency program in the country (that’s not hyperbole, we all think we’ve had the best training) and I wanted to make a difference treating patients on the brink of death. But instead, I ended up with complaints like, “I was almost stung by a bee!” I confess, I sometimes actually looked around for a Candid Camera crew that was pranking me, but they were never there. The bee sting patient was serious, he really was almost stung and he really did want to know what to do the next time. All I could mutter was, “Maybe you should almost come back.” Not my best moment. This poor guy had waited two hours and was probably charged hundreds of dollars only to be told to “almost come back.” The one thing it did do was to fuel my motivation to help deliver care in settings that are most appropriate: emergent issues go to the ED, lesser medical priorities select other options.

My personal goal was to keep the “almost stung by a bee” visits out of the ED. So I opened an urgent care center. After a while, I was able to open a lot of them. We learned a lot, made mistakes and treated hundreds of thousands of patients… but we made little difference in the grand scheme of emergency care. Exhibit A: Yesterday, a patient came into the Level One, tertiary care center where I work and he said, “I just got Obamacare and I want to get checked out!” That wasn’t just one of his complaints—it was his only complaint.

I’ve gotten over a bit of my drive to try to change the world. Ok, I really haven’t, but, I stay fiercely motivated to truly changing the delivery of on-demand healthcare. As caregivers, we needed to peel the onion back one more layer. Cue virtual care.

In 2010, I moved one step closer to delivering true, no-waiting, price-transparent, on-demand care. I started a virtual care company called MeMD. That’s right. We started addressing on-demand care by serving a patient’s needs in a virtual, technologically enabled environment, rather than in an exam room. Face to face, rather than person to person, if you will.

Fast forward three years and our company now has providers in nearly every state, treating everything from sinusitis to gastroenteritis, and directing patients to the nearest urgent care center or ED when their care cannot be triaged virtually. Getting back to my “bee patient” and the thousands of others who continue to revert to the ED for minor complaints, I can say with certainty that there are at least 30,000 patients who might have gone to the ED if not for the intervention or direction we offered virtually.

Truth be told, there’s one element of the virtual care environment that is still a bit of a mystery to me: People are incredibly excited to use it. Seriously, I can treat a rash or give a parent advice about their sick child, and I am treated like Moses parting the Red Sea. This is clearly not as challenging as making a life-saving decision in the ED (which I had the good fortune of experiencing recently, a completely lucky diagnosis of Boerhaave Syndrome), but it’s satisfying nonetheless.

As a caregiver, which experience is more satisfying? I must admit that when I treat and e-prescribe for a patient virtually, I honestly feel more like a lost Mayo Brother than when I can catch that once-in-a-lifetime horrendoma and save a patient’s life. I often ponder why this is so rewarding. It is fun and exhilarating to use new technology on the leading edge of medical care. There is also a “back to the future” component of it where, using virtual medicine, we are actually making a house call. I suspect, it is this combination of the “old” and the “new” that is so intriguing. Despite my penchant for wanting to treat only the sick and dying, I thank God for virtual care and sometimes feeling like one of the Mayo Brothers!

If anyone would like to build on this discussion, you can find me on Twitter, @JohnShufeldt, or talk with me at the upcoming UCAOA Convention!

For those attending the UCAOA National Urgent Care Convention next week, stop by booth #525 to learn how we connect care so urgent care leaders can connect action to results – more revenue, better quality and satisfied patients and physicians.

Dr. Shufeldt is the founder and CEO of MeMD, an urgent care telemedicine company providing a virtual consultation platform to more than 100 urgent care centers in 20 states nationwide.

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