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Published on May 02, 2016

Need a doctor fast, but not an ER?

Need a doctor fast, but not an ER?

On a rainy Saturday in April, there isn’t a lot of drama at Stoneman Outpatient Center just off Route 130 in Sandwich.

And that’s precisely the point.

Stoneman is home to one of four “urgent care” treatment centers that are part of Cape Cod Healthcare. The other three are:

All four centers are meant to improve access and convenience for those who have health problems that are not critical and are unlikely to require specialists, sophisticated lab tests or IV treatment.

Think conditions that feel urgent to patients but are rarely life-threatening, like:

  • Ear infections
  • Sprained ankles
  • Rashes
  • Strep throat
  • Flu symptoms.

Conditions that need emergency room attention are quickly redirected and they include:

  • Chest pain
  • Potential cardiac issue
  • Head injury
  • Significant abdominal pain with vomiting and fever

While staff are experienced and trained in emergency care, their focus is treating the smaller complications of life when a visit to your family doctor isn’t an option either because it’s after hours or you’re far from home. They save patients from ER waits and ER insurance co-pays and keep ER staff concentrating on emergencies.

Since 2008, there’s been a 16 percent rise nationally in the number of urgent-care clinics, up to 9,300 this year, according to the American Academy of Urgent Care Medicine.

“We are busiest when other medical people aren’t working,” said Bruce Stelle, MD one of the Falmouth Hospital emergency medicine physicians who takes shifts at Stoneman Urgent Care. “A lot of these things happen off-hours or on weekends, or when doctors are not in their offices, or they happen when a patient or families cannot get themselves or child to the doctor.”

Cape retirees are often hesitant to give up their long-time hometown – and off-Cape – primary care doctors, who are too far away for routine sick visits, he said. That’s where the urgent care centers come in.

And of course, tourists and seasonal workers have traditionally turned to Falmouth and Cape Cod hospital emergency rooms, making them among the busiest in the state. Urgent care now gives them another option.

The Urgent Care centers are taking on the non-critical load. Patient visits to Stoneman, for example, were up 13 percent from 2014 to 2015, from 17,277 to 19,597. The center sees an average of 60 patients a day, although it can jump to 100 a day in the summer, Eric Fortier, one of the Stoneman physician assistants, said.

Staffing usually consists of one doctor, a physician assistant or nurse practitioner and two nurses, but increases during peak times – Fourth of July weekend, the day after Thanksgiving, Christmas week, according to Dr. Stelle.

Stoneman’s light-filled waiting room seats about 30 and has the usual doctor’s office array of magazines. There’s a pharmacy and about a half-dozen exam rooms. Staff moves room to room like trick-or-treaters, evaluating patients, taking vitals and cultures, delivering diagnoses.

The atmosphere on this particular day was doctor’s office calm, rather than emergency room bustle – no beeping monitors, ambulance sirens, clacking gurneys or police radios. Just some quiet chitchat behind the desk, the slight scent of Dunkin’ Donut’s coffee and the occasional cough from an exam room. Flu was the most common diagnosis of the day.

But in one exam room, Christine Anderson, 64, sat holding her right wrist, which was sore and swollen after lifting weights and doing planks.

“My wrist just started killing me after exercising,” said Anderson, who recently moved to Mashpee from Connecticut, where she was familiar with urgent care centers. She first tried her primary care physician, but the office wasn’t open on Saturday. Within 40 minutes at Stoneman, she’d been seen by a doctor and had X-rays and was waiting for a diagnosis.

Care centers are not meant to replace primary care physician services or to treat chronic conditions. Staff does not, for example, have access to patients’ primary care medical records.

To help determine where their condition is best addressed, Dr. Stelle suggests that patients either start with a call to their own doctor or pediatrician, or one of the outpatient centers.

“We’ve made a conscious decision to have a human answer the call,” he said. “And if one of our receptionists can’t answer the question, you’re going to talk to a nurse or a doctor.”