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.
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
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Losing consciousness for any reason = ER. A friend passed out during dinner and we weren’t sure what to do, so we called the triage nurse and they were like “ER now!” (He was fine, they never figured out what happened and it’s never happened again, but it’s definitely stayed with me.)
It’s happened to me a while back because of a likely electrolyte imbalance. I actually passed out in the hospital urgent care because I had gone in for feeling so shitty. Then they call an ambulance to take me from the urgent care doors to the ER doors across the parking lot. Of course the first thing they did before the ambulance even got there was put a saline IV in so by the time I got to the ER I felt perfectly fine and the tests didn’t find anything. Doc said I probably just had low sodium. That’s also where I learned for the first time that SSRIs sap sodium from your body which seems like something they should tell you when they put you on them.
How much for the ambulance across the parking lot? I would crawl rather than pay.
Lol. $1200. That was literally the minimum because the invoice listed 0 miles and no supplies used. If they would have let me crawl then I would have.
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.
It’s just the palpitations and I’m willing to bet that it’s going to just wind up being something stupid like a potasium deficiency or something. But thats a good point, I could just go get an EKG done and rule out an impending heart attack then make a clinic appointment for this issue. It just sucks having to pay for two visits.
Also it’s just anoying because this isn’t the first time I’ve been stuck in the department decision paralysis. The last time I wound up going to urgent care and then immediatly having to go to the ER for a damn gall stone that had aparently been an issue for months by that point. Once again having to pay for 2 visits when I could have just gone directly to the ER.
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.
I’m in the US and I can do this. I call my primary care, they connect me with a nurse, and I tell them what’s going on. They will then inform me if I should go to UC, ER, or wait for an appointment. The primary care office even has a walk in clinic as an option. This is why it’s good to have a primary care physician, even if insurance doesn’t require it.
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.
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Yeah, and that’s exactly what I’d tell a patient. But it’s just anoying when it’s me and I know that it’s almost certainly going to be something dumb like a potasium or iodine deficiency or something like that. Like I logically know you’re right though, this does fit into the “cardiac symptom” = “go to ER” formula.
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.
I once had an interesting conversation with a nurse at my GP’s office. I was scheduling an appointment with my GP. The nurse asked what I wanted to see him about. I mentioned light headedness, dizziness, globus, chest pain, palpi-
She stopped me at “chest pain” and said “I’m going to write down chest pressure, because otherwise, they’ll send you to the ER.”
At the time, I was scheduled for all the heart tests you can think of and a few neurological tests and had been having chest pain daily for months during which I’d had plenty of heart tests already. And the nurse was familiar with my case. Had she not been, she definitely would have just sent me to the ER.
She made the right call. All the heart and brain tests came back fine. Nobody ever saw fit to give me a diagnosis beyond “your nervous system is too sensitive.” (I asked if he was talking about “dysautonomia” and he agreed to that. Not a “diagnosis” per se, but better than nothing.)
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.
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.
Thank you for answering the base question and not giving medical advice.
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”.
How do you know my dad?
This is why healthcare in the US sucks.
- A wealthy person will have a 24-hour hotline to connect with a nurse or doctor (immediately or through return call) with access to their medical history who will help them figure out what to do.
- A moderately well-off person will have a web/phone interface where they can send a message and someone will return their message in a day or two.
- Everyone else has to make a gamble: do I spent money to try to figure this out? Do I risk spending money and then it turns out to be nothing? But what if it’s something and it’s more expensive later on? What will my insurance pay for? How do I find someone that’s reliable, but also inexpensive? All of this causes stress which makes things worse.
In your case, think of anyone who knows your medical history and who you can ask questions of. The doctor who prescribed your anxiety medications - can you call/message them and ask them? The pharmacist who dispenses the meds - can you go/call and ask a question about your medications? Some pharmacies also have nurse / clinic stations, too. If you have any kind of medical insurance, check out their web page - a lot of them have set up tele-medicine offerings recently. If your job has an HR department, this is actually one case they can be helpful; an HR person in my company helped me figure out what health resources I had access to, based on my plan. Finally, if you haven’t been getting annual checkups, you should start thinking of doing so (especially as you get older), and ask them how you can contact them to ask questions like this.
Good luck fam, I hope it turns out OK for you.
There’s a hospital very close to my house. Less than 2 minutes away.
Twice we’ve driven there (the person driving did not have the issue in question). Both times it turned out ok, but everyone at the hospital felt the need to lecture us that we “really should have called for an ambulance”.
I said wow, you guys really want that $2,000 taxi fare for nothing.
There are definitely times when you should call for an ambulance. But it enrages me when you know it’s only about the fucking money, but they give you the concerned sanctimony attitude.
Yeah, my area used to have a really good public nurse line where you could just call in, tell them what was going on, and based on your medical history on file they could roughly triage you and tell you where to go. But I imagine keeping it running was cutting into the hospital exec yacht fund so they cut that service.
I could always message my primary care doc but normally I just catch one of the nurses and they just tell me to make an appointment. Considering my primary care doc is always booked solid 6 months out I almost never bother going that route unless it is for an anual exam or something. My meds are just through a chain pharmacy so the pharmacist won’t know much about my particular situation. Someone else had mentioned insurance offering telemedicine too so I will definitely be looking into that one. I also happen to be on the medical response team at work so I am intimately aware of what our offerings are for healthcare options (practically nothing). Also I am 100% on the regular checkup train. I will ask my doc if there is something to fill the place of the old nurse line at my next checkup.
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.
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.
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).
PSA for those in the US; the Urgent Care type places that advertise “ER” in their title will be absurdly more expensive than “regular” Urgent Care places that do not advertise as such.
The reason is that the “ER” places have actual ER type equipment, but regardless if you use them or not, you will be charged as such.
Maybe this is common knowledge, but we learned the hard way when my partner went in for something very benign and we received a $1,000 bill, even though we had insurance.
These “ER” places are popping up everywhere, and there’s nothing to tell you that if you go down the road a block or so, it could make the difference between a cheaper co-pay and owing the full amount. In our case, almost $1,000.
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.
It comes down to what’s open, how dangerous the condition is, and who was outfitted to do what.
If you’re having legitimate trouble breathing like you are filling your lungs and it’s not enough, or you can’t get enough air in your lungs for any reason, straight to the ER.
Unknown irregular heartbeat or chest pain that doesn’t go away with antacid, go to the ER.
Urgent cares near me generally have x-ray equipment. They’re capable of a few stitches, they can handle prescriptions for emergent illness. If you walk in there with a f’dup heart rhythm or breathing problems they’re going to call you an ambulance.
Scheduling something with your primary care is for all your other long-term needs. Preventative maintenance, blood tests, they can probably do an EKG and they should be the ones managing your long-term medications.
If you have something that feels urgent and the urgent care isn’t open the ER is always an option.
