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.
If you already know what is wrong and just need a doctor’s note (and maybe antibiotics), go to the clinic.
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.
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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.
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 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.
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.
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.
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.
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.
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.)
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.
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.
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.
For what it’s worth urgent care will definitely tell you to go to the hospital ER if they deem it more emergency related. And of course they’ll still bill you for coming in there to ask them :P
In other words urgent care is not emergency care, if that makes sense.
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.
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.
Former EMT here: The body has a way of sending you to the ER lol
Lol. I do definitely know a few people of the “sit on it till it’s septic” school of thought when it comes to going to the hospital. Not surprisingly they’re all medical professionals. My step dad is literally a paramedic instructor and if I had a dollar for every time he wound up the the ICU for an issue that was “nothing, I’m fine” then I could buy myself a decent beer.
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.
