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.
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.