Dr. Christopher Chao Q&A
For many people who might not feel quite right after a fall, bump, or jolt, their local urgent care facility is an accessible way to get evaluated for a possible concussion. Not only are urgent care centers often easier and faster than waiting to get in to see a primary care physician, they’re also often less expensive than immediately heading to the emergency room.
Over his career as an urgent care physician and through his work as President of the College of Urgent Care Medicine (CUCM), Dr. Christopher Chao has seen the difference it makes when urgent care providers have the knowledge and resources they need to evaluate a patient for a potential concussion.
We sat down with Dr. Chao to talk about how critical it is for both urgent care clinicians and patients to understand concussion symptoms, and what he’d like to see in his profession moving forward to ensure the urgent care community has the resources to help even more concussion survivors get the diagnosis and treatment they need.
Let’s start at the beginning and give a bit of context for this conversation. Can you tell us what urgent care medicine is?
Urgent care is an ambulatory clinic that sees patients on a walk-in basis. Urgent care clinics serve patients with a variety of acute medical conditions when they either aren’t able to see their primary care physician in a timely manner, or when they need care but it’s not something significant or severe that would require them to go to the emergency room. In the United States, there are over 14,000 urgent care clinics nationwide.
When patients come into urgent care, what are they looking for?
Typically, patients that come into urgent care know something’s not right with their bodies, but aren’t quite sure what’s going on. In the context of what we’re discussing right now—concussions—most patients aren’t coming to urgent care thinking, “I have a concussion.” They’re thinking, “I fell and I don’t feel right, so I’m getting this checked out.”
Nationally, we do see many people coming to urgent care with concussion symptoms for three reasons: 1) they don’t know where else to go, 2) it’s significantly less costly to go to urgent care over the emergency room, especially if you don’t have health insurance, and 3) the wait time is much less.
Let’s say someone has hit their head or experienced a fall. As an urgent care physician, what’s the first thing you do in evaluating them?
Our first priority is to ensure that the patient does not have a medical emergency and requires immediate transfer to the Emergency Department. Next we make sure that the patient doesn’t have a significant head injury that requires emergency care or hospitalization. Does this patient need observation? Does this patient need a CT scan? We want to make sure there isn’t any bleeding. When you get bleeding in a fixed area like your skull, it creates pressure—and there’s nowhere to relieve that pressure. It can cause serious injury or death. Not every head injury requires a CT scan; sometimes, the history and exam are sufficient to allow for discharge home.
After we evaluate patients with more serious head or brain injuries, we help determine the kind of care that’s needed and work with the patient to develop an appropriate rehabilitation and healing plan, depending on their symptoms. We suggest that patients either follow up with their primary care physicians or follow up with us if their symptoms persist or get worse.
You’ve treated many people for concussion symptoms in urgent care—and you’re also leading teams of physicians to do the same. What are some of the ways that patients—and physicians—can create more awareness around concussion symptoms and what to look out for?
When it comes to patients, the biggest thing is awareness. Awareness that concussion symptoms don’t always present immediately. They could emerge after a few weeks, or a few months. And, that they might persist for weeks, or months, or even longer.
For physicians, it’s an awareness that there’s no “classic” presentation for a concussion or a brain injury. Not all of the signs are the same, and no two brain injuries are alike. Even if it looks mild, or isn’t presenting as a serious injury, we need to be prepared in case it might be.
Let’s say you could wave a magic wand and make one aspect of concussion diagnosis easier and better for both patients and clinicians. What are you changing?
Better resources and better continuity. I’d like us to be better able to connect the dots between rehabilitation and follow-up care. There are a lot of instances where a patient will come to urgent care, they’re told it is a mild traumatic brain injury (TBI), they’re told to follow up, and there’s not a lot of continuity. Some cities have concussion clinics that we can refer them to, but if you live in a rural area, you might be hours away from one.
And, if we don’t have a concussion clinic that can help that person, I’d love to see more resources so that a larger number of clinicians feel more comfortable managing brain injuries—getting more education to clinicians is paramount. I’d like to be able to give that continuity of care to everyone who experiences a concussion, no matter what the severity.
If you could give a piece of advice to potential patients around concussion symptoms and care, what would it be?
It’s so much of what the Brain Injury Association of America says already, but if you experience a fall, or hit your head, get it checked out even if you think everything’s okay. There’s so much about concussions that are unpredictable, and there can be hidden symptoms or injuries you might not be aware of.
This is especially important if you’re a high-risk patient—someone who’s elderly, or on blood thinners or other anticoagulants. A concussion might affect you much differently depending on your age or which medications you take.
The other piece of advice I’d give is to shift your perception around concussions. They aren’t just for kids or adults who play sports. Most concussions happen because of everyday activities—an elderly person taking a tumble out of bed. Someone slipping on a wet surface in their house. A car accident. If more people understand that concussions can occur because of the activities and actions we do every day, that would be a huge step forward in awareness. And when people are concerned about their back, or a sore shoulder, they should also pay attention to their head, too.
I know you mentioned most concussions happen as a result of everyday activities, but for a moment, let’s talk about the link between concussions and sports. Anything you want to say there?
Sports are a huge part of our culture here in the United States, for kids and adults of all ages. I know how important they are when it comes to high school and college culture. I love sports as well—I’m an avid runner. Where sports culture gets messy is when someone does get injured, they’re not feeling right, and they shake it off because they don’t want to miss out on playing the big game, or they’re afraid of letting their team down. And sometimes parents and guardians shake off the symptoms, too.
I remember one day I walked into an exam room and talked with a high school football player who was experiencing intense headaches. I evaluated him and said that I thought he might have a concussion. His mother was instantly angry at me. “You don’t know that,” she said—and abruptly walked her son out of the exam room. She didn’t want to admit that her child might be dealing with a concussion.
The reason I bring up this anecdote is that if you ignore the signs, you might wind up dealing with a larger injury than the one you initially came in to get checked out.
How can urgent care clinicians spread the word about concussion awareness to the patients they see, knowing the time you typically have with them is limited?
I think that’s just it—we need more time with patients. More time to evaluate them, more options for following up with them.
This isn’t quite what you were asking, but it’s an important piece of my advocacy as someone who’s guiding other urgent care clinicians—and that’s having the conversation about clinicians having the time and space to level up their skills and knowledge about concussions and traumatic brain injuries. How we manage concussions today vs. 20 or even 10 years ago has changed dramatically, so it’s important for our skills to stay current.
We need to feel more comfortable when we’re evaluating patients with brain injuries. So, I always tell clinicians, “Stay up to date on the latest research, the latest diagnoses, the latest rehab recommendations. Having that knowledge—and imparting your knowledge to your patients—is one of the best ways you can help your community.”