Generally when you have something simple, like a cut, bruise, etc., if it is during your doctor's business hours, you go to them and they examine you and give you a prescription for pills, ointment, etc. If it's more serious, like awful stomach pains, s/he may send you on to the medical clinic at the hospital right then. Or if it is after business hours, if it's pressing enough, you can also go to the medical clinic at the hospital without a referral. But generally if it is a chronic problem, the idea is to wait until you can see your family doctor, and then get a referral to a specialist from him/her.
OK, for background on my part: I am 33-years-old. I had a serious stomach surgery back at the end of May. My surgeon had to repair both ends of my stomach. It was so complicated that my original surgeon had to give my case to the chief of surgery, because I am kind of a medical freak of nature ;-)... I have a problem with my pancreas, a hole in my heart, uterine problems... and these things (birth defects, mainly) were only diagnosed within the past 2 years! Thankfully, they caught the stomach problem in time, because my stomach was, unbeknownst to me, on the brink of rupture. So the surgery saved my life.
I also need to have surgery on my uterus. So after the stomach surgery and recovery, I went back to my gynaecologist and hospital so we could sort out everything with my uterus, and try to prolong not having the surgery for as long as possible. So there's been a LOT going on with me medically. And in the middle of it, over a period of several months (even before the stomach surgery) I have been getting more and more dizzy.
But last week the dizziness was really bad. And finally this past Monday, it scared me very much. I was stumbling around, falling over and seeing fuzzy edges around things. When walking I had to slowly put one foot after another. I tried to just lie down but things were just getting worse. So around 9 PM, I asked my husband to take me to the after hours clinic at the hospital. It's true - the dizziness had been going on for months. But it had been scary bad that day and I was practically having double vision, etc.
It's a slow night at the clinic - only one or two people in front of me. I've been there several times before (one time via ambulance). Usually when I go, I start filling out a form, the nurse kindly asks a couple of questions, takes the form to the doctor, and asks us to take a seat, or to lie back in a reclining-type chair, if needed. They are always very nice to me.
This is where the bad service comes in. I haven't gotten far enough on the sheet to write my symptoms, so the nurse asks what they are. I start telling her about the daily dizziness, and how it's gotten worse --
She cuts me off, and says, 'Um, so why are you here? I mean, why are you bothering to come after hours, if this is a chronic complaint?'
I try to explain that, yes, while I've had the dizziness for a while, that day it had gotten so bad that it was scary to me. I mentioned that I had had a major surgery there in May, so she would get the idea that I'm not just some random hypochondriac.
She raised her eyebrow. 'So you had the dizziness since then? Why are you just now trying to address this??'
I have never had anyone in that department talk to me like that before! So I stumble, 'I..uh.. I...' I am so flustered I just hand her the clipboard and I'm like, 'OK, never mind, forget it, I can go home -'
She goes , 'No, no, wait wait wait, go and have a seat at the end of the hall.'
So we do that, but the longer I sat, the stupider I felt (a very big emotional trigger for me). My husband wanted me to stay, but after maybe 10 minutes I just couldn't manage. I felt so crazy and unwanted so I just got up and walked out to the car. I know that I could have told them I was leaving, but I was too embarrassed to interact with them.
My husband came out to the car, and said he had told doctor and nurse that I had left, and that the nurse looked really embarrassed and that the nurse and doctor said that I was welcome to come back any time.
Given the nurse's reaction, they had probably looked in the system and saw my medical history - the last several entries in my record being from my surgeon, the CHIEF OF SURGERY. When I was in the hospital, nurses and even other doctors on the surgical floor had been afraid to piss me off, because they didn't want me to report them to my doctor. Some of them had literally stopped me in the hall to ask how I was feeling. As a matter of fact, they don't even call him by his name, but rather 'Der Primar', which is a title that is basically like 'Distinguised Chief Head of Department and all that is Holy'. Here in our culture, doctors are held on high, anyway - but a Primar? God. Allah. Buddha. Brahma. They are not to be pissed off. So I bet both the night nurse and doctor were very nervous to have scared me off so badly that I just walked out.
In my opinion, the nurse could have just neutrally said, 'Have a seat, the doctor will be with you shortly' - no commentary, no nothing. Or even if she felt like she had to ask why I was coming for something that seemed chronic, she could have done so much more nicely, and actually listened to my response. Then they would have had like 5 or 10 minutes to bring up my medical history in the system and save themselves from potential embarrassment. Because I'll bet that her tone with me would have changed once she saw my record.
But this is why I didn't follow the usual chain:
First of all - the dizziness had gotten scary worse that evening!
Secondly, I already mentioned this to my family doctor several times! He gave me a medication which helped a little, not much, and then he blew the issue off. So, I had already done my part with him.
Now, as for going to the day clinic? My stomach and uterine problems had been diagnosed there by accident. I can't tell you how many times I went to my family doctor and the hospital (one time by ambulance) because I was having bad stomach pains. And I was always, ALWAYS told 'gastritis' and told to take medication. Finally one time it got so bad I went again and said the pills weren't helping. Now, I will give one of the attending physicians credit - he suggested I be sent to gynaecology. That was how they discovered the uterine problems. But otherwise, the attending said it was just constipation and gastritis and was ready to send me on my way. But the resident who was the last to see me didn't agree. She asked the attending if I could get a gastroscopy and he said no. But she went behind her boss's back and signed me up anyway. So, basically, my life was saved by a disobedient resident.
So I'm not overflowing with confidence in the day clinic.
But I had noticed that the several times when my husband was sick and I brought him in at night, it was a different story. When brought in during the night, you generally get an admission and therefore they kind of have to start testing you, and continue that in the morning. But I got no such consideration from day clinic until it was almost too late.
So, yeah... even though I was coming in with something that is technically chronic, had the nurse not been so rude about it, I would have been able to explain all that and given them a basis to probably work with me - especially given my history. But given the anxiety/panic/etc. that I struggle with (and yeah, meds only sort of help with that)... I could just not deal with staying in a place in which I felt unwanted.