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Welcome back to Urgent Care Unscripted.

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I am Barbara Brant. Alter.

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And this is Mohamed Salah.

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And we also have, our,
medical director, Felix Pacheco,

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with us.

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today we will be talking about,

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we started talking about
many different healthcare topics,

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but today's focus is on
when treatments don't work

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and how communication plays
a big role in the way forward.

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And, thank you for joining us.

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Yeah.

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Thank you, Doctor Felix.

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Thank you. Happy to be here.

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So, we'll start with,

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a couple things
that are important to patients.

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And I think it's a big topic
for urgent care world

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is what happens
when the treatment doesn't work.

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So some things to consider are, you know,

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whether or not
obviously the diagnosis was correct.

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There's some
so that may be correct. But the illness,

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sometimes suffers a complication.

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And a good example is like from media,
you know, if you develop new symptoms,

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you know, maybe it's not the same illness,
but rather the complication

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of the previous illness. Yeah.

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Another thing to, take into consideration

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is that providers often consider a disease
process in terms of a time frame.

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It's something that takes longer,
you know, not the same.

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And depending on your,
like risk factors, age and whatnot,

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those have to, you know,
be taken into consideration as well.

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Another thing to consider is
whether or not the treatment was correct.

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You know, sometimes, either
the treatment was,

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incorrect for you, meaning
that it could have been treatment for you

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because of antibiotic resistance,
for instance.

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Or I think,

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towards tolerance to the medication,

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but sometimes, you know, adherence
or in adherence to the medication regimen,

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you know, so
these are all things to consider also.

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And, Doctor Felix,
when it is still not working,

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it's great to know from,
many different perspectives of why

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it's not working, but what kind of patient
do in that situation.

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So for all the reasons mentioned before,
a provider needs to know

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that this happened may because, 
a treatment failure or incorrect diagnosis

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cannot be something that will determine
if we do not know about it.

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So, for communication with the provider
to ensure

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that your symptoms are,
you know, resolving or worrying.

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So. Got it.

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And if it's, if it's a viral infection,
does that is that any different way

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that the patient should be addressing
or approaching it versus a bacterial.

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Can you tell us more about, between us
versus viral situations?

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So most of is, is do not require,
any specific treatment.

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Obviously there are some exceptions.

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You know, Covid is,
one that was very prominent recently.

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You know, influenza or the flu, might be,

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something in which treatment as well,
or depending on your risk factors.

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Right.

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Now, because there's an overlap
in presentations,

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bacterial illnesses
and by organisms may present the same.

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And that's the point of seeing a provider
to hopefully make the right determination

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whether that access actually is needed
to make sure there's no pneumonia or,

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maybe some other testing
that we have available at the clinic,

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for instance, like Covid testing
or flu testing that

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we can easily evaluate for,
and potentially rule out.

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And if it's something positive,
whether or not treatment is necessary,

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that's great.

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Can you tell us a little bit about
since you mentioned viral infections,

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versus let's say bacterial infection,
can you tell us why?

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A lot of the times providers are reluctant
to prescribe antibiotics.

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So a couple of reasons.

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The most common,
which is the lack of a benefit of,

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treating a viral illness with
an antibiotic that targets the bacteria.

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So it would be inappropriate management.

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And because of that,

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you can have, you know, some people
who don't tolerate antibiotics.

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Well, another key I distress,
maybe some diarrhea,

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disrupting the gut microbiome.

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Additionally,
there's a possibility of adverse effects,

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like an allergic reaction. Right.

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And then in terms of long term
exercise complications,

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increased prevalence
of antibiotic status,

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meaning that bacteria
evolve to, tolerate these antibiotics.

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So you want to preserve them
as best as possible, because diets

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maybe antibiotics in the,
in the pipeline for, you know, future use.

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With that being said, at what point?

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Because I think a lot of patients come in,

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they get diagnosed with a viral infection,
and then they come back,

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you know, a week later,
I'm not still feeling better.

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And then they do get prescribed
by antibiotic at that point.

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Why why is that?

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A couple of reasons.

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There's always the possibility
that the initial diagnosis is incorrect.

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There's also the possibility
that you had a, post-viral complication

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in which you actually developed
a bacterial infection after

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an infection could by infection,
can sometimes be at risk.

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So thanks to, this is such that,
it makes me more dead at that point.

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But, underlying all this,
you know, communication is key.

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You know,
if you're not, recovering as expected,

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then you should have the evaluation
and communication with the provider.

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A potential GP visit.

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To the clinic in order to ensure
that you're actually getting better

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or that new treatment is, given,

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if needed, here, if the urgent care
and what's even we do

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next day
follow up calls, we do understand that

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you're not going to get better
within that next day,

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but it's important for us
to let the patients know at that point.

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We do have this line of communication
open with you.

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We want to make sure you picked up your
prescriptions or if you had any questions

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at the visit that you were not able to ask
or didn't get an answer on.

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We can answer that question.

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At that certain point.

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I also want to mention, with that
being said, is

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coming in for a follow up if you're still
feeling not feeling better.

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Sometimes we might ask you to come in
for a follow up.

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We do have an x ray tech on site,
so it might be necessary

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for the provider to diagnose
you and get that chest x ray or whatever.

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Or another point of care testing
or just repeat testing.

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So it's really important
that we communicate with the patients

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and let them know that those are options
for them.

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Yeah.

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Just to keep that for our patients

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in mind, that a follow up
call to ask for guidance

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to inform your provider
where you are in your process of recovery,

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that really in most cases
does not cost you anything.

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That communication really can take
you much further along

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the whole process of recovery versus
you are thinking sitting at home

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and not bothering others
could, could be a better choice.

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No, it may not be the best choice
in many situations.

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So we advise always to stay in touch
with the plan and keep us informed.

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And let us know how you're doing.

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The the other thing, the, the,
Pacheco that we also see,

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is that how does a patient decide, like,
should I really at this point,

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we will have down the road
a full episode on this, deciding between

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an urgent care visit and your visit,
but they have, some kind of an injury.

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It could be

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just a cut on their finger,
or it could be an accident or

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an accident, or it could be something more
severe than that.

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And how can they decide, like,
do I go with this injury?

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Do I look good?

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I didn't care, do I was but emergency room

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or just sit at home
and try to treat it with a Band-Aid?

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The first thing is, you know,
very important question trying to decide

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between to and you have to consider
the severity of the illness.

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Obviously, it's,

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in certain cases, and that's probably

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not a good place for you to get evaluate,

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dealing with a more severe illness.

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If there's some confusion
and loss of consciousness,

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if there's difficulty breathing
these or, more concerning features

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that follow any traumatic injury,
if it's a, you know,

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Kid Kingdom playground and has a floor
and is bruised

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or, a laceration
that, you know, isn't too deep,

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there is an exposure
or an exposure, right?

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Those kinds of things,
we can easily, like, treat, you know,

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you get cleaning I think on today's
episode, we covered topics.

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We covered about, when treatments
don't work, how should it be handled?

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We covered about, bacterial disease
versus, viral infections.

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We've covered about how follow ups on

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and to ear communication is important
in the process of recovery.

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We talked about your visit,
versus urgent care visit a little bit.

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Appreciate everybody joining in.

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And, listening to
and watching our episode.

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We will have more,
episodes down the road.

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We appreciate you joining and subscribing
to, Urgent Care and scripted and,

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and enough to warrant doctor, Pacheco
for helping us out in this, knowledge.

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Yeah. Thank you so much, Doctor Pacheco.

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And again,
you can find us and Doctor Pacheco here

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at 5354 Sawmill Road in West Haven.

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Again, a of the urgent care.

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And we're here to serve you.
And we'll see you next time.