this post was submitted on 28 Sep 2024
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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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[–] [email protected] 2 points 1 month ago

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.

[–] [email protected] 3 points 1 month ago

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).

[–] [email protected] 6 points 1 month ago* (last edited 4 weeks ago)

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.

[–] [email protected] 5 points 1 month ago

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.

[–] [email protected] 14 points 1 month ago (3 children)

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.

[–] [email protected] 2 points 1 month ago (1 children)

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.

[–] [email protected] 3 points 1 month ago

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.

[–] [email protected] 1 points 1 month ago (1 children)

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.

[–] [email protected] 2 points 1 month ago

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.

[–] [email protected] 5 points 1 month ago

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.

[–] [email protected] 1 points 1 month ago* (last edited 1 month ago)

always the ER

the clinic in my area has no available appointments until several months out so it is the ER or hope your condition is something that can wait a long time before treatment

[–] [email protected] 10 points 1 month ago

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.

[–] [email protected] 6 points 1 month ago* (last edited 1 month ago) (1 children)

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.

[–] [email protected] 3 points 1 month ago* (last edited 1 month ago)

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

[–] [email protected] 1 points 1 month ago

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.

[–] [email protected] 4 points 1 month ago

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.

[–] [email protected] 4 points 1 month ago

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.

[–] [email protected] 7 points 1 month ago

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.

[–] [email protected] 6 points 1 month ago* (last edited 1 month ago) (1 children)

Former EMT here: The body has a way of sending you to the ER lol

[–] [email protected] 1 points 1 month ago* (last edited 1 month ago)

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.

[–] [email protected] 11 points 1 month ago (1 children)

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.

[–] [email protected] 3 points 1 month ago (1 children)

I drove myself to the hospital while having a heart attack in 2018. About 45 minutes after I arrived I had a stroke.

[–] [email protected] 3 points 1 month ago (1 children)

That's insane. If it doesn't bother you, how did it feel? How long was the drive? What happened afterwards?

[–] [email protected] 3 points 1 month ago

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.

[–] [email protected] 11 points 1 month ago

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.)

[–] [email protected] 2 points 1 month ago* (last edited 1 month ago)

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).

[–] [email protected] 4 points 1 month ago* (last edited 1 month ago)

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).

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