How do I semi-urgent-care doctor?

August 6, 2017 11:56 PM

I have a minor health issue (details below the fold, but think "minor infection" not "unknown major ailment."). I have insurance and should should see a doctor about it, but for various reasons, I'm not quite sure how.

One of my toenails is ingrown and infected, with some abcess-looking stuff going on. I've been washing it, keeping it wrapped in gauze, and hoping it would clear up on its own, but it hasn't for a couple of months. I should really go see a doctor and get it taken care of because it's somewhat painful, and I'm sure easy to resolve.

However: I spent most of my 20s underinsured in college or grad school. I'm now in my 30s and on a PPO, so insurance is not an issue. On my 20s, I got so used to "this will be cripplingly expensive and/or the on-campus doctors will be incompetent and make things worse" that I used them only for crisis, and I never established a PCP when I moved and got a real job.

Where do I go or who do I call, for this sort of "I need medical care soon but not immediately" type issue? I believe it's not severe enough to warrant the ER. Is urgent care a good next step? I originally said "I won't bother trying to call a podiatrist because I bet it will be months to get an appointment and I don't want to wait months," but now I've waited months anyhow! I guess ideally I'd like to get a doctor to look at it and confirm that things are stabilized and not getting worse, at the very least, even if I can't get it treated/resolved immediately. I have insurance coverage and income so I'm not really worried about cost, more "I don't actually know how to do this basic adult thing that I clearly should know how to do."

posted by anonymous to Health & Fitness (15 answers total)

Get an appointment at an Urgent Care clinic pronto! Infections can spread to the bloodstream if untreated, and that is very bad. Luckily you are probably right and this is likely easily resolved. Look up your local Urgent Care clinic and early tomorrow call and make an appointment at the earliest time you can make it. That's it really. I would urge that if your toe suddenly Really Really hurts, more than somewhat painful that you suck it up and go to the ER. But unless that happens- yeah this sort of thing is what Urgent Care was made for.
posted by Homo neanderthalensis at 12:01 AM on August 7, 2017 [2 favorites]

When I need a doctor, I go to my health insurance website and use their doctor search so I can find a doctor who is "in-network." I don't know how your health insurance works, but if they do have a network of doctors, it's a lot easier and faster to go on their website than it is to call around and keep asking, "Do you accept my insurance?"

I think any primary care physician could be your first line of treatment on this. Also, in my experience, you shouldn't just assume you can't see a specialist, in this case a podiatrist, quickly. It really depends on how many of a certain type of specialist you have where you live. I once had to book months out for a dermatologist, but then in a different city, I would able to get an appointment that week. Same with gynecologists. It all depends. But I should note, some insurances won't cover you seeing specialists without a referral from a primary care doctor, so you should check that too while you're on the health insurance website.
posted by AppleTurnover at 12:17 AM on August 7, 2017 [6 favorites]

Oh, one more thing to add, primary care doctors usually keep slots open for patients who have medical issues that need to be seen right away. Just ask and if it's not quick enough, call another doctor on the list of in-network doctors. I usually go with an office with a lot of doctors so someone will be able to see me. I bet you could get in to see a primary care doctor fairly soon, and if it's a positive experience, then hey, you've found your PCP. That's how I got my current PCP, basically.

I doubt the receptionist would try to send you to a physicians assistant (PA) but, just keep that in mind as something you don't want. If they go with the first available appointment, ask for the name of the doctor. I usually look them up to see who they are before I go. You can always cancel and go to someone else.
posted by AppleTurnover at 12:29 AM on August 7, 2017 [3 favorites]

I assume you're in the US. Make sure to check with your insurance company first. You may need a referral for a specialist. Oftentimes an urgent care clinic will be covered without referral. Do yourself a big favor and check first!
posted by mightshould at 3:18 AM on August 7, 2017

In your shoes I personally would call around to some podiatrists. Don't assume it will take a long time to get in as this may not be true! As AppleTurnover points out, many doctor's offices keep urgent visits open for patients who need them. I don't think that podiatry offices have the issue about wanting you to be an established patient before seeing you for a problem focused issue. Definitely check on the need for a referral as you may not need one.

AppleTurnover's advice is very good regarding primary care doctors and true, however, most primary care doctors (not all, but most) shy away from procedures, and if you need an abscess incised or to have the ingrown nail addressed directly (which we usually do by cutting it!) they probably will not do that for you.

I'm an ER doctor (although not your doctor, not medical advice and all that) - and I do see people sometimes for ingrown toenails, and I believe I am capable of treating them, but I am sure a podiatrist would do a more skillful job since it is their area of specialty. As far as infection goes, I usually tell people if the area is getting significantly more painful, getting a red streak or growing area of red skin around it, or is draining significant pus (or if they have signs of systemic infection like fever as well as local infection), that they should be seen urgently.
posted by treehorn+bunny at 3:58 AM on August 7, 2017 [5 favorites]

You should check this, but since you're on a PPO, you most likely do not need a referral from a primary care physician to see a podiatrist. Here's what I would do:
1) Call insurance (number on the back of your card) to confirm that you don't need a referral.
2) Find podiatrists with good reviews online.
3) Use insurance website to figure out if podiatrists are in network (you can ask the insurance rep to tell you how to do this during step 1).
4) Call in network podiatrists until you get one who can see you quickly. This may not be as hard as you think.
posted by peacheater at 4:07 AM on August 7, 2017 [3 favorites]

Having experienced what your problem is, I'm completely with treehorn+bunny on this. Call around to podiatrists. Their office staff will have dealt with this before. You should be able to get to see somebody in the next 24-48 hours.
posted by kuanes at 4:08 AM on August 7, 2017

tl;dr Find a way to get to a podiatrist. They will do a 5-minute procedure which makes the toenail a bit smaller and it will never get ingrown and infected again.
posted by JimN2TAW at 5:45 AM on August 7, 2017

Agree with the above that you should try to go straight to a podiatrist, since a PCP may or may not be able/willing to handle your toe in their office and may send you to a podiatrist anyway. This is what my fiancé did for his gross toe and it was the right move. A lingering infection is not great for your body, and there's also a small risk of an infected ingrown toenail spreading to your bone, which is something you do not want.
posted by MadamM at 5:47 AM on August 7, 2017

I also recommend making an appointment for a podiatrist. I had the same infected ingrown toenail removed three times. Once at a primary care office, once at an urgent care, and once at a podiatrist. Both the primary care and urgent care extractions were very painful post-procedure. When I finally went to the podiatrist, he fixed it with minimal pain afterwards. I asked him why it hurt so much the last two times, he explained that they had performed the procedure in an older, more invasive way. 1000% would recommend a podiatrist.
posted by Guess What at 6:06 AM on August 7, 2017 [1 favorite]

I just re-read, and noticed that you were concerned about a long wait until you can book an appointment. Ymmv, though I was able to make an appointment within a week of calling the podiatrist.
posted by Guess What at 6:19 AM on August 7, 2017

If you're in San Francisco, memail me for a rec for a fantastic podiatrist.
posted by janey47 at 6:32 AM on August 7, 2017

In the meantime when you get home, soak your foot in hot salt water, as hot as you can stand it. As soon as the water cools, get more hot salt water. Do this several times and you should see the infection goopy type stuff resolve. If you can see a place where the nail is into the skin, try to lift it out as best you can and if so place a small amount of cotton under it to keep it lifted up. This was my life in high school due to wearing cute shoes, :-) Then the podiatrist can trim things up to hopefully stop it from happening again.
posted by PJMoore at 9:47 AM on August 7, 2017

Sure, podiatrist is the best answer. But if that gets frustrating or you cannot be seen today, Yelp for a good urgent care and go there. If you've got decent insurance, it'll be cheap, and they'll make sure you're going to be OK and send you off to a podiatrist if that's necessary. Basically, if you're the sort of person who gets frustrated at how complicated this whole system is, urgent care is great, they'll fix anything they can and tell you how to deal with the rest.
posted by Pacrand at 11:54 AM on August 7, 2017

To address your larger question of "how do I adult in this situation?"
Your typical General Practitioner will have a way of seeing people on short order.
In my doctor's practice, they have an early morning slot for walk-ins, first come first served.
Other practices will have one or more physician's assistants (PAs) who are available to take care of most typical minor things (my doctor's practice does not have this, but other doctors I've used have). Call and find out what they have.
Typical things that I've used the walk-in for:
minor back injury
pain/difficulty swallowing
high fever
persistent coughing
posted by plinth at 7:10 AM on August 8, 2017