Thirty-one-year-old Latoya Archer woke up Friday morning for the fifth day in a row with a cough and a cold and decided it was time to see her doctor.
The H1N1 flu strain has hit one North Charleston family particularly hard.
The problem was her doctor's office was closed.
So Archer, of Goose Creek, like thousands of other Lowcountry residents and out-of-towners this Christmas season, paid a visit to a nearby urgent care center. She didn't know the staff there and they had no access to her medical record, but this "doc in a box" accepted her insurance plan and was - crucially - open for business.
"When did symptoms start?" asked Dr. David Robinson, a family physician at Roper St. Francis Express Care in North Charleston, around the corner from the Tanger Outlets on International Boulevard. (Technically, Robinson isn't a "doc in a box." He's a "doc" in a shopping mall.)
"Monday I started coughing," Archer said.
"Monday - so that's about four days ago?" Robinson asked.
"It really didn't start getting bad until Tuesday," she said. "I felt the chills and the weakness Tuesday and Wednesday. On Thursday morning, I didn't really feel the chills anymore, but the cough was still there."
Robinson said the vast majority of patients he treated this week have presented symptoms similar to these. It is, after all, high season for infectious disease.
During the week ending Dec. 21, 2,422 positive rapid antigen tests for the flu were reported around the state to the health department. They may not all prove to be actual cases of the flu - but they represent thousands of patients who felt sick enough to seek medical treatment.
"A lot of sick people," Robinson said. "I think a lot of our local providers have earned a few days off during the holidays, so a lot of our offices are closed. ... The patients, they are obviously still getting sick over the holidays. They still need a place to go."
Roper St. Francis Express Care anticipated such an influx this week that it stopped accepting regular appointments. On Thursday and Friday, the entire schedule was reserved for walk-ins only.
Dr. Barron Nason, who owns five urgent care centers in this area, said his facilities will likely treat 15,000 patients in December.
"It's a lot of sick people," Nason said.
Urgent care is more of an umbrella term for a spectrum of facilities ranging from pop-in primary care clinics staffed by nurses and nurse practitioners, such as CVS Minute Clinics, to full-scale physician-staffed emergency care centers, such as Nason Medical Center.
There are more than a dozen urgent care centers in the Lowcountry and an estimated 9,000 in the U.S.
"Urgent care means a lot of different things to a lot of different people," Nason said.
They often provide a quicker, lower-cost alternative to hospital emergency rooms, especially for lower-level emergencies, such as broken bones or persistent cases of the flu. Conveniently, urgent care centers are also usually open hours after regular doctors offices close.
But some experts worry that they may end up costing the health care system more money because patients are using urgent care as an alternative to not only the ER, but as an alternative to their family doctor.
"At times, they're nice because it's a place my patients can go at night or times when I'm not available to see them," said Summerville physician Dana Simpson. "But there is that tendency that anytime something comes up, 'I need to be seen right this minute.' "
"I certainly have seen a lot of people that could have called us and gotten advice over the phone that wind up going two or three times over the course of the weekend," she said.
A report published this year by the Center for Studying Health System Change noted that the impact of urgent care centers on health care costs is still unclear, but S.C. Medicaid Director Tony Keck said their potential to save the system money is worth a gamble.
"They're obviously less expensive than going to an emergency room," Keck said. "A lot of people on Medicaid have jobs that they can't take off easily from - they need to have options outside normal working hours."
The agency recently created a new provider category called "convenient care clinics" to expand primary care and after-hours options for Medicaid patients.
"We're trying to encourage more of these. We really think of them as access points. We want more access points," Keck said.
Robinson described Roper St. Francis Express Care, which opened in October, a little bit differently than typical urgent care centers - more as a family practice that accepts walk-in patients. The hospital system's website says the clinic is designed for patients who "need to see a doctor right away, in the evening or on weekends." It's also a business-savvy strategy to funnel new customers into the Roper St. Francis Healthcare system - especially patients without existing relationships with other primary care doctors.
"The patients want to be seen," Robinson said. "They don't necessarily want to wait a long time and that's part of the reason I think this model works so well."
Archer, who was diagnosed with a bronchial infection on Friday morning, was in and out of the doctor's office in under an hour.
"Have you had a flu shot?" Robinson asked Archer at end of her appointment.
"I just never got it."
"Why not?" he persisted. "You're going to be back to see us in a month."
Reach Lauren Sausser at 937-5598.