What to Do When the Office is Closed.


J. Greene



      It's one of those unwritten laws of nature:  Any really annoying medical problem is most likely to occur late on a Friday afternoon. It's too late to call the doctor's office, which is probably closing. It doesn't hurt enough to go to the emergency room. But the nasty cough or bladder infection will be enough to put a crimp in your weekend plans.
And the Friday Night Rule has a corollary just for parents: If your toddler's going to get an ear infection, it'll happen at the most inconvenient time possible — just as you've finished packing up the car for that long-planned vacation.
 If this is such a common occurrence, why hasn't the medical world responded to it? It seems like the doctor's receptionist and the HMO on-call nurse figure you should be able to tough it out and stop whining until regular business hours. And God forbid you should go to a hospital emergency room and run up a big bill if you have an HMO.
Depending on where you live, though, there could be a simple answer: The Doc-in-a-Box.
The preferred medical terminology is "urgent care center." You might find several in the Yellow Pages under "clinic" or "medical." Or your health plan may provide one. The nice thing is that they're often open late during the week and on weekends.
      If you're dazzled by the array of ads in the phone book, consider picking one that's associated with a hospital or academic medical center. Check to be sure it is licensed by the appropriate state agency. Also ask about the credentials of the doctors, nurses and other staff. And when you're done, be sure to have the medical record from your visit sent to your regular primary care doctor.

 One potential drawback of the local doc-in-a-box is the chance the fee won't be covered by your HMO insurance. To avoid getting stuck with the bill, scope out the local walk-in clinics ahead of time so you know where to go in an urgent, but not emergency, situation.
If you have an HMO plan, be sure to go to its own urgent care center. If you have a more permissive PPO plan, check your listing of approved doctors to see if the local after-hours clinic is there. You can also try calling your plan's authorization number to double-check; just be sure that if the person on the other end of the line gives you a thumbs-up that you can make it stick. Take down the person's name or an authorization number.
Over the past few years, many hospitals around the country also have set up these off-hour clinics just to keep your piddly little problems out of the emergency room, which is meant for, well, emergencies.
That saves the hospital or health plan money, plus it means that if your problem turns out to be serious enough that you need hospital care, they'll whisk you right into their own facility. That's known in the business as "patient flow."
Members of Kaiser Permanente health plans and some other HMOs have long had access to walk-in clinics that are available on evenings and weekends. Some other health plans do so as well, but it's still a good question to ask when you're picking a plan: Do they offer evening and weekend care outside of the emergency room? Or if you're picking a doctor group, ask what they will do for you if you have a serious problem at odd hours. Is there a physician on call all the time?
 Medical groups may be increasingly aware of the need to see patients outside of normal business hours, although they still have a ways to go. A survey of physician groups conducted by the Medical Group Management Association in 1997 found that 300 of the surveyed organizations offer patient care on evenings and weekends, while 202 groups did not.
      Even though these walk-in centers may be handy in a pinch, don't rely on them for your regular care. It's better to try to establish an ongoing relationship with your primary doctor, whether that's a family practitioner, an internist, a pediatrician or a gynecologist. If the medical group you see is so busy that you can't get seen on short notice, consider finding another doctor.

And if you have a true medical emergency, don't hesitate to take it to a hospital's emergency room. Such problems might include severe cuts, burns, unconsciousness, a temperature above 103 or a drug overdose.
      How to know the difference between an emergency and an urgent health problem? Your ho
spital may help out; many of them have 24-hour nurse/help telephone lines that can help evaluate your problem and recommend a course of action.



                                                                                    Good Health Return
                                                                         Good Health Return