Emergency room or urgent care? How to know where to go
Sometimes an emergency is obvious — but not always. Use these 6 questions to help make the best decision about where to go for your care.
Most of us know what to do in a serious medical emergency. If someone is in severe distress, having a seizure, or we can’t bring them to the emergency room, that’s what 911 is for. We also know to call our doctors about a nagging symptom, chronic condition, or minor illness. But what about the area in between — when it’s outside normal office hours and you’re in pain or need care fast? Should you go to the emergency room or urgent care?
“It can be hard for patients to know whether some conditions or symptoms are life-threatening or not,” says Jennifer L. Brull, MD. Dr. Brull is a family physician in Plainville, Kansas, and is on the board of the American Academy of Family Physicians. “Even if you know what’s wrong, it can be a question of: ‘It’s 11 p.m. Can this wait until the next morning or not?’”
First, some general rules of thumb. With a few serious exceptions, your primary care provider (PCP) should be your first call, no matter the time. Emergency departments can be busy. They will always care for the most critical conditions first. If you’re not directed to the emergency department by your doctor and your situation isn’t immediately life-threatening, it may be best to go elsewhere. Making the right choice can save you time and possibly money.
If you can’t get into your PCP’s office and it’s not a clear emergency, your other option is an urgent care center. “Urgent care centers care for a broad range of minor illnesses and injuries, including simple x-rays and rapid lab tests for strep throat,” says Bradley J. Uren, MD. Dr. Uren is an associate professor of emergency medicine at University of Michigan Medical School in Ann Arbor.
He lists the following symptoms as things that can all be evaluated or managed in an urgent care setting:
- Mild to moderate pain.
- Minor bleeding.
- Minor sprains or injuries to joints or extremities.
- Discomfort with urination.
- Minor upper respiratory symptoms.
- Sore throats, coughs, and fevers.
If you’re still not sure if you should go to an emergency room or urgent care, here are some other questions to ask before you head to either.
1. What does my primary care provider say?
You don’t have to make the decision between emergency room or urgent care on your own. “Almost all primary care offices have some way for you to consult a physician or other provider even after hours,” Dr. Brull says. “They are a wealth of information, in part because they already know your health history. I see a lot of folks who don’t take advantage of this resource.”
If it’s outside of office hours, most PCPs have a phone recording that offers a way to reach the provider on call. Don’t be afraid to use it. Your question is the exact reason someone is on call. You can explain your symptoms and concerns and ask questions. And you can get their advice as to whether you should visit the ER or urgent care or wait to see your usual provider.
2. Is my life, a limb, an organ, or my health at serious risk?
Say you can’t reach anyone at your physician’s office. Or maybe you have a sense that you can’t wait to call them and may need the ER. Answering “yes” to the above question is part of a legal definition that dictates emergency care. It’s known as the “prudent layperson standard,” Dr. Uren says.
“It states that ‘if a person without specific medical knowledge believes that their symptoms, without medical attention, are likely to result in serious risk to their health or permanent organ or limb dysfunction, it is reasonable to seek emergency care,’” says Dr. Uren.
There are federal and state rules and definitions on the books to regulate the way some insurance decisions are made about coverage for emergency care. But “this framework is the best to consider in any potential medical emergency,” Dr. Uren says. Chest pain is a good example. “It can be caused by many conditions. And although many of those conditions may not be life-threatening, it’s also a symptom of a heart attack, which can cause serious injury or even death,” Dr. Uren says. “So generally, the services of an emergency department are required to evaluate chest pain completely.”
Other common symptoms where time is key and you’re likely best served in the ER:
- Symptoms of a stroke. These include weakness of an arm or leg, facial drooping, or slurred speech.
- Any injury that causes severe bleeding or deformity of a limb, or if a bone is visibly out of place.
- When pain is out of control.
Other factors to consider
“When it comes to something that may ultimately require surgery, or if you’re saying to yourself, for example, ‘I broke my ankle,’ versus ‘I wonder if I broke my ankle,’ the ER will probably be your ultimate stopping point anyway,” Dr. Brull says. “Most other stuff can be taken care of in urgent care — or when your doctor’s office can see you.”
3. What conditions do I have, what am I at risk for, and what have I been treated for in the past?
This is a question to think about before you are in a possible emergency. Get your doctor involved too. During your next appointment, talk about what conditions or symptoms you may be at risk for and what signs to monitor. And work with them to come up with a plan for what to do if you have any milder but concerning symptoms.
This is important because symptoms don’t have to be severe to be an emergency, Dr. Uren says. Say you can’t hold your phone normally. Weakness in a hand may seem minor. But it’s a sign of a stroke. And if it comes with other non-serious-seeming symptoms of a stroke, you need treatment ASAP by the emergency department.
On the other hand, some severe symptoms might not need emergency care if you’ve had them before. Take the symptoms of a panic attack, such as shortness of breath, chest pain, and sweating. These can be the same as a heart attack, which seems scary. But panic attacks aren’t dangerous. This is good to know if you tend to have them. It could save you a trip to the ER.
4. Are my symptoms getting worse?
The first onset of symptoms might not tell you whether your condition is severe enough for the ER, Dr. Uren says. But if things start to head south relatively quickly, that can be a sign. “Appendicitis that may require emergency surgery can have symptoms that progress slowly over hours or a few days,” Dr. Uren says.
Ideally, though, you’ve already talked to someone at your PCP’s office for specific advice about how to watch your condition (see No. 1, above). “When I talk to someone on the phone who is having shortness of breath, for example, I can tell when it’s a big deal or not,” Dr. Brull says. “If you can speak a full sentence without taking a breath, you might want to go to urgent care. But if it turns into gasping for breath every few words, then you need the emergency department.”
5. What does your gut tell you?
Don’t ignore the little voice inside you that says something serious is going on. If you can take a few minutes to call your physician’s office and talk to the on-call provider, do so, Dr. Brull says. But also keep this in mind: “Gut feeling may be another way of stating the prudent layperson standard,” Dr. Uren says. “Nobody should ever delay emergency care if they believe their life, limbs, or organs are at risk.”
6. Am I prepared for the emergency room or urgent care?
Wherever you end up, be sure to plan ahead as much as possible. Bring your insurance card and a list of your medications and allergies. “We’ve been seeing a lot of platforms that help track and integrate your health history,” Dr. Brull says. Wellframe, for instance, is a digital health management mobile app that helps you store and share your medical history. “In situations where you’re not feeling well, these platforms and printouts can help make sure you relay all the important information,” Dr. Brull adds.
Other ways to be prepared: If you’re in distress, be sure whoever drives you to the ER or urgent care can stay with you and advocate for you. If you’re not in distress, bring a snack and something to read. You’ll probably end up waiting — longer in the ER, but urgent cares may have wait times of more than an hour, especially at peak times.
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