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.
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).
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.
If it’s new shortness of breath or chest pain , particularly the crushing variety that feels like something is sitting on you, do not pass go, do not collect money, straight to the ER. Same goes for sudden severe lower back or abdominal pain or sudden heavy bleeding out of your orifices (more than a super maxi-pad full every two hours if you’ve got that genital configuration). There’s a few other little things like a continuous erection more than 4 hours. Also you should learn the signs of a stroke (Google “stroke FAST”). If you’re not sure, look up the local ERs number (not 911) and ask for the “triage nurse” and ask them.
If it’s been going on / steadily getting worse for over a month it can (probably) wait one more week if that’s all it will take to see your primary care physician or see a specialist.
If it’s sudden but you know exactly what you did like if you pulled a muscle or sprained a joint at work or cut or burned your arm while cooking (I specify arm, if you cut or burn your hand, face, or foot, measure how big it is and call that triage nurse, and if it’s your genitals just go to the ER) or if you forgot to pee after sex or did it with somebody sketchy and now it hurts to pee, go to the urgent care. Or if your petri dish of a preschooler brought home something and you’re not sure if it’s strep but you almost definitely need a note for work. Or if you have an old cut but now it’s looking puffy and oozing weird liquids (but it’s still localized to that one little area, you don’t have a fever or anything). If you can look at it and already have a general laymans idea of what they’re gonna do to it, go to the urgent care.
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
Oh yeah I was thinking about adding head bumps but forgot / wasn’t sure where to add it.
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.
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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
For anything heart related (including shortness of breath/lightheadedness) I’d go ER. If I had a nickel for every time some ‘normal and fit’ <30 year old fell over dead at a half marathon I’d go buy a beer. I mean it’s probably and hopefully nothing but if you do have some very serious condition and your heart stops every second counts by a lot, and a lot of times it’s basically punching the Konami Code, you’re otherwise normal and a confluence of things just line up precisely and boom. And with anxiety and all it wouldn’t hurt to just get a professional to rule that stuff out
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.
i tend to use the pain scale to give me a hint on decisions like this. so i guess the first question to ask before the pain scale is “am i in a state of shock?”
note: i am not in any medical field nor had intensive training.
If you have insurance, they typically have a hotline you can ask about stuff like this.
Ours is through our provincial healthcare system, but the service might be similar for you depending on where you’re located:
https://www.healthlinkbc.ca/more/about-healthlink-bc/about-8-1-1
Ooh, that’s a good idea. I’ll have to go check on that. Thank you. I knew our local nurse line was dead but I didn’t consider that my insurance may have one.
Your insurance should have a nurse line. If not, your company likely has a employee assistance program (EAP) that might be able triage.
If you in the US, you’re primary care doc’s office wil havel an after hours number to call if you’re not sure. Unfortunately you’ll likely be told to go to the ER if it’s heart related because we have to err on the side of caution since we can’t evaluate you very well over the phone. Urgent cares are hit or miss since they’re staffed mostly by mid levels who may or may not be well trained but they can handle sore throats/colds, simple cuts/infections/foreign objects, STD testing, etc. depending on their facilities. I’ve been to one without basic labs which is crazy. I’d suggest calling you doc’s office first to see if they have acute visit slots that day. A lot will.
If it’s bugging you not knowing and you don’t want to wait until your clinic appt, then yes, urgent care would be able to at least tell you if it’s an emergency cardiac event and send you on to the ER, or if it’s something like afib and it can wait to follow up with an office visit.
Afib, which commonly causes palpitations, should be seen in the ER if you can’t get in to your PCP that day. Could be caused by a lot of things and a work up is warranted including lab work, echo, etc if new.
Very good points. I based my comment on a personal experience with family, and they were not endangered by waiting a few days to see a cardiologist. I didn’t know there could be other causes that are critical enough for the ER. But I should have guessed because I know it is similar with tachycardia. Sometimes someone’s had too much Red Bull, and sometimes it’s a birth defect in the nodes in the heart and heavy sedatives are needed to calm that down.
Oh yeah, a lot of common causes need to be evaluated plus we need to assess if the person should be on blood thinners due to the risk for a clot in the heart that can travel to the brain. I’ve admitted quite a few patients for new onset Afib due to their underlying causes as we didn’t think they were good to go home. Admittedly most people would be fine and we can be too cautious due to legal liability and physician anxiety over bad outcomes but considering the possible consequences, it’s not a terrible thing to do that.
That’s a good point, when in doubt urgent care can at least rule out anything immediately concerning.
Stitches don’t necessarily mean ER.
Guess it really depends on your urgent care.
For the most part, I’ll go to my urgent care unless I know damn sure ER is needed (the urgent care is in my network). It’s no farther away, (ER is a couple blocks away), and urgent care is less out of pocket. If they determine ER is required, they’ll say so (and recommend ambulance if they feel it’s necessary).
Basically the triage nurse will assess and make a determination.
I’ve had family go there for cardiovascular issues (and be treated and sent home). They’re fully equipped to stabilize someone if they need to go elsewhere. They have a full complement of equipment, including radiology (everything but CAT).
Possible heart stuff, always go to ER. Stuff of low concern like a mild rash that hangs around or mole you want checked out, go to clinic. Broken bones are ER. If you need stitches but don’t think the cut is so crazy big and deep that it severed tendons or anything, urgent care can stitch you up.
When in doubt and you need something done quickly, just go to the ER. At the least you can ask the check in nurse if it’s something urgent care can probably handle and if she says yes, just bail out and head that way. It’s cheaper, and the ER is always filled with people who may need help that UC can’t do.
There are a range of tachycardia/arrythmia that you can have since birth that may not show up until you’re older, or get triggered by certain meds or nutrient deficiencies (things like potassium).
I wouldn’t ignore this for a minute longer. Maybe just walk into urgent care and ask if they’re equipped to check it out (basically EKG). I know my urgent care is.
If they aren’t equipped, then go to ER.
But please don’t sit on this any longer. Some arrythmias are fairly benign, but if it’s happening repeatedly, it will eventually cause tissue damage that you don’t really fully recover from. Plus you don’t know if yours is benign (and most docs would say arrythmia is never benign, even if it isn’t killing you in the moment).
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.
Urgent care 8snt typically a good place to go to for possible heart issues at all, actually. Some d9nt even keep an ekg machine on hand.
That’s why I said usually. EKGs are common where I’m located, might not be the same in your area. It’s not that hard to read an EKG, even I could tell you whats normal and what’s fucked.
But you can’t just go off an ekg. You also need blood work done to see if you had an mi that resolved itself, so going to urgent care is useless. Beyond that it’s stupid and dangerous, because if you are having or get an mi there, the facility isn’t equipped to run a code.
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.
Do you have a primary care physician? I think this going on for 2 weeks warrants talking to them about it. If it’s not changing, then the urgent/emergency need isn’t there. Getting to a specialist could be months or over a year though (took me 10 months for first-available appointment with a cardiologist who specializes in dysautonomia issues like I have; someone I met in the waiting room waited closer to a year and a half).
Alternatively, if you have insurance many of them have a nurses line you can call and get input. Like you mentioned you would do as an EMR, they’re likely going to recommend you go to the most extreme care (ER) because they don’t want to risk being wrong. But they might be able to talk you through your doubts. And hey, if it’s insurance they have motivation to get you to the cheapest care possible, so maybe they wouldn’t recommend ER after all, lol.
Lastly, since you’re stuck in decision paralysis, it might be worth taking some actions on your own to see if you can improve the situation. Obviously this isn’t the smartest option, but I know I’m stubborn, cheap, and have white coat anxieties after being dismissed for my health issues my entire childhood, so I tend to go this route often. (Heck, I waited until my mid-30s to seek care that ended me with a cardiologist despite having the symptoms literally as long as I can remember.) You mentioned potassium deficiency and my immediate thought when reading “palpitations” was electrolytes as well. If you have a history of high blood pressure ignore this, but if not, eating salt and getting magnesium/potassium can help a ton. My cardiologist insists I eat 7-10 grams of salt a day. It’s a fuckton, but hell if it doesn’t make me feel worlds better.
ETA: I just want to reiterate my last idea above is a bad suggestion. But I know that’s likely what I would do, so I mention it anyway. Also I had frequent palpitations throughout my life as some of the symptoms I ignored, but I didn’t actually know those were “palpitations.” I thought “my heart is just beating hard/fast today,” and that palpitations meant something…else. It was less than a year ago when I learned it just meant awareness of your heart beating, and I can’t even explain what I thought it meant before that, other than more than that.
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.
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.
