How are you supposed to decide where to get care for emergent conditions? Where is the dividing line between “just book a clinic visit”, “head into urgent care when you get a chance”, and “go inmediately to the ER”?
So this is a question I’ve always struggled with and it makes me feel very dumb especially because I literally am a EMR. This feels like something I should know. But at the same time I have also called to book a clinic visit before and had the scheduler tell me to go to the ER immediately only for it to wind up being nothing.
Certain things are obvious of course. Like if I need stitches or there is other major trauma then I know to go to the ER. If it is something like a concerning infection then I know urgent care can sort me out. For a skin rash that’s probably a clinic visit. If urgent care is closed and it can’t wait then default to the ER. But there are also the issues where I genuinely don’t know on what side of the line they should fall. This is especially an issue for things that have been going on for a while which I know could be severe but almost certainly aren’t.
For example (not asking for medical advice) I’ve been having repeated extended periods of heart palpitations for the past 2 weeks. At first I just chalked it up to screwing up my anxiety med schedule while I was on vacation because my med situation does cause heart palpitations if I screw it up. So I didn’t think much of it at first but now I’ve been back on my meds properly for 2 weeks with no change. So, that’s cardiac symptoms which in a patient would make me tell them to immediately go to the ER just to be safe. But at the same time it’s been going on for 2 weeks and it’s probably just some vitamin deficiency or something so it probably wouldn’t kill me to wait a week for a clinic appointment (no walk in clinic here). Do I split the difference and go to urgent care? It’s like schrodingers medical issue, it’s both the worlds most benign thing and a symptom of immediate death until someone looks into it, so how do I know who should open that schrodingers box?
It seems like there has to be some easy dividing line on how to know which one to go to that I just don’t know.
Edit: In USA, because that probably matters here.
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Great criteria. Another “straight to the ER” one is loss of consciousness; people get knocked out in movies all the time so it’s easy to assume it’s fine, but it’s not.
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I work in 911 dispatch, it drives me nuts how many people lose consciousness for various reasons, and then when they come to they say they’re fine and don’t need to be checked out.
There’s maybe some very narrow exceptions for people with known conditions that they’re already managing with the help of a doctor and they know exactly what’s causing it.
But in general, if you’re losing consciousness that’s a bad sign and you need to see a doctor about that ASAP
Since you’re in the US I imagine my method won’t apply to you, but just in case, or for other people reading: in my country there is a phone number you can call in situations like this. They have doctors, nurses and specialists on call, initially you talk with a nurse that asks triage questions once you’ve explained your problem they give you advice for home treatment, if relevant, or send you to the correct urgency level care, including already sending the information on the triage questions to wherever you are going.
Called once to ask, they said go to urgent care.
Then billed me for a telehealth visit and also the Urgent Care billed me too.
USA, Land of the free
to pay🤷 in my country it’s all completely free. Once I had a bad cold they even called me back the next day to check in if I was doing better.
Oh i love the nurse advice line. My experience with that line is that their advice is “if it takes more than a bandaid to fix it, you need to go to the emergency department” and they’ve never heard of urgent care.
I’m pretty happy with the one in my country. I once mixed up some medication times and they escalated to a doctor that then put me on hold to consult a pharmacist just to be sure. I would have spent 7 hours in ER just for a doctor to tell me that I was fine, and instead I just waited a bit on the phone.
If you already know what is wrong and just need a doctor’s note (and maybe antibiotics), go to the clinic. While their staff are significantly more skilled knowledgeable than the general public, their policies limit them to only simple diagnostics and treatments. Your medical knowledge is certainly less than that of the Nurse Practitioners and Physician Assistants that staff these clinics, but likely exceeds the scope of practice they are limited to by their employer. If you don’t know what the problem is, the clinic is going to refer you to your PCP or urgent care anyway, so you should only visit the clinic to appease HR or get access to basic prescription medications.
If something is bothering you, but you can tolerate it for a couple weeks, schedule an appointment with primary care.
If you don’t know what’s wrong, or you need something more than a note and a prescription, and you can transport yourself, go to urgent care.
The only time you should go to the ER voluntarily is if urgent care sends you there. Any other trip to the ER should be because someone dragged you there without giving you a choice.
Where I live, we have a special phone line we can call to talk with a nurse. While most people know when to call 911, when your unsure what to do, the nurse can give you tips, tell you when and if to book an appointment in a clinic, when a pharmacist could be of any help, or what to do to treat yourself if you don’t need medication (like, drink this, apply hot or cold somewhere, etc).
I’ve kinda learned over time what is appropriate for what through personal experience or by listening to others. I also ask myself questions like can it wait a couple of days? Being in America I also ask myself is it worth going to the ER for this? Someone mentioned too that a lot of insurance companies now have nurses you can call for this sort of help.
If you genuinely think it’s life threatening, go to the ER. If it’s something that isn’t life threatening but should be taken care of ASAP, then Urgent care is a good choice. Something like a broken bone, stitches. They have a lot of equipment. If they can’t treat you or discover it’s something worse they will send you to the ER.
I had an issue with heart palpitations a few year ago. I went to my primary care doctor and then went to a specialist. I think total it cost like 300$ or something. I was worried it was something worse yeah it turned out to be stress and anxiety. But the specialist did rule out any heart problems which included those scary ones where healthy people drop dead. That was worth the peace of mind. If I had gone to the urgent care they would have ruled out any immediate life threatening conditions and then have you follow up with your pcp or maybe get you to the specialist.
You got the right idea. Heart problems are a bit of a mystery until you can get an EKG done. Urgent cares aren’t usually equipped to do more that that. If it’s ongoing, maybe look for a cardiologist. But if you’re having any sudden shortness of breath then you might need to head to the ER.
Depending what county you live in, etc. There are nurse hotlines that you can call. That said I’ve never used them.
We used to have one in my area but they stoped doing it a while back I’m assuming just because it wasn’t making anyone any money. Can’t just do something solely for the public good after all.
Okay this is easy if you’re an American. Whichever one’s the cheapest, unless it’s an obvious life or death situation or head injury. That’s it.
Clinics are when you can call ahead to make sure they can handle your issue that can’t wait for a GP appointment. Your burning genitals or deep cut will be seen at their earliest convenience. They can be used for GP services if you do not have a regular care provider.
Hospitals are for when you were referred there, have an on-going issue, or no clinics are open. You are not in urgent need of medical intervention, or are man enough to die in the waiting room with your 104° fever and almond smelling cut you got from a fence two weeks ago that has dark veins radiating from it because “it’s nothing, just a cut”. You can use them for typical GP services if you don’t have a regular care provider and many offer clinic services.
GPs are for regular checkups or visits for something you are concerned about.
ER is for when dispatch calls ahead for you, severe pain, severe injury, unconsciousness, or OD. Expect to wait for hours if you are conscious and not leaking, because others are and you aren’t the main character today.
Dude, if you’re having heart palpations, go to fucking urgent care. That shit can be lethal. Atrial fibrillation? Atrial flutter? They can cause blood clots which can cause stroke. Urgent care will know what to do, even if that’s just calling a cardiologist elsewhere to look at your EKG or even stuffing you in an ambulance and driving you to an ER.
Don’t want to take medical advice from a rando on the internet? (You shouldn’t!) Then call your goddamned nurse line. They will sort you out and tell you exactly where to go.
Good luck.
My general hierarchy…
Something chronic, or changing, go to a Dr.
Something rashy, uncomfortable or parasitic, go to clinic.
If you call an ambulance, go to the ER.
Can it wait however long it takes to see a specialist? Are you ready to pay $2k for a 15 minute ambulance trip?
If the answer is no, urgent care
If you are capable of driving yourself, it’s 90% of the time not worth going to the ER. If it’s actually during working hours and you have a primary care doctor call them first.
I drove myself to the hospital while having a heart attack in 2018. About 45 minutes after I arrived I had a stroke.
That’s insane. If it doesn’t bother you, how did it feel? How long was the drive? What happened afterwards?
I had horrible pain in my back between my shoulder blades. I spent a week in the NCUU ward and 2 years of speech and physical therapy. I have been out of a wheel chair for over 5 years. My left side is partially paralyzed but I can walk pretty well with a cane. I can’t walk a mile for exercise so I take 3 shorter walks adding up to a mile a day on good days. I have plenty of bad days but I am alive and thankful for every day.
