A photo from Bautista Medical Group Sunnyside shows Dr. Juan Bautista with two patients. Photo via Bautista Medical Group's Facebook profile.
Written by Edward Smith
One Fresno medical group has shifted its focus to caring for patients who may otherwise go to emergency departments that are carefully marshalling resources amid the COVID-19 crisis.
The doctors and nurses at North Fresno Primary Care and Bautista Medical Group Sunnyside normally provide primary and routine care, including sports medicine cases as well as internal and family medicine. But now, the four doctors, nurse practitioner and one physician’s assistant have taken on the work of providing urgent and emergent care.
Dr. Juan Bautista and his medical group wanted to find ways to take some of the stress off of emergency rooms. They began by reaching out to their own patients, encouraging them to come in for urgent needs for which they might otherwise go to the emergency room. They even went so far as to post on social media that they were now open for urgent care.
Bautista sees a number of doctors as his own patients. They are also spreading the word and sending patients to North Fresno Primary Care and Bautista Medical Group Sunnyside.
One student nurse Bautista knows who is working on becoming a nurse practitioner had a woman come into the hospital with knee pain. She referred the patient to Bautista, who drained her knee and gave her an injection to treat the inflammation.
While she spent an hour at the ED, Bautista said getting treated at his office likely saved her hours she might’ve spent at the hospital.
On Monday morning, Bautista consulted with a patient suffering from a urinary tract infection related to a previous stroke. She was also worried that she was having another stroke. Bautista was able to have a tele-health appointment with her and determined she wasn’t having a stroke, which kept her from having to go to the hospital altogether.
“Instead of going to the ER and getting this big work-up of a CT scan, we’re able to do a lot of that urgent care stuff at our office,” said Bautista.
When word of coronavirus first arose, there was talk around the office of shutting down, as some urgent cares have done in response to threats from contracting coronavirus. But they decided to stay open.
Now, Bautista and his partners are seeing between 30-40 patients a day, many of them remotely. That number is typical for them, but in order to treat urgent needs, they’ve had to call patients to cancel or reschedule their routine checkups.
“What we’re trying to do is just keep the regular visits at home and then the urgent visits at the clinic. You can say we’ve had an increase, but we’ve had an actual decrease in terms of physical contact with patients,” said Bautista. “That’s the main thing we’re trying to do for the ERs.”
And even though North Fresno Primary Care doesn’t take every kind of insurance, Bautista doesn’t want that to be what keeps people from being healthy. He’s done some pro-bono work and reduced prices for cash payments.
“With some of these patients, if they’re not on my network, I’m not going to deny them care and tell them to go to the ER,” said Bautista. “That would be contraindicating all the ethics we just talked about.”
For people coming in exhibiting coronavirus-like symptoms, he wants to be able to handle the case while minimizing risk of exposure. Patients who say they have fever, chills and shortness of breath are met outside of the office with masks and gloves and brought in through a separate entrance into a different room. Some staff members have expressed concerns, and he’s given some of his employees a chance to go home, but he’s reminded staff of the importance of their work.
Bautista himself has self-isolated from his family, living out of his recreational vehicle while his children visit.
“A fireman signs up to put out fires, a teacher signs up to teach kids, we sign up to take care of sick people, that’s my job,” Bautista said.