Paging Dr. Frischer: Urgent care vs. ER

You have an urgent need for medical care. Let’s consider your three main options: your primary care doctor, urgent care…or the emergency room.

My own medical group is often able to offer a same-day work-in policy, but this has become rare for most primary care practices, and even we cannot accommodate everyone who calls in. Sometimes we can help over the phone, but that still leaves some of our patients in need of a rapid assessment. What remains is either an urgent care clinic or the local emergency room. Each has advantages and disadvantages, including cost and time, but here we will focus on the medical indications.

Primary care works best when you have an ongoing relationship with a provider. Routine health needs include annual well visits, vaccinations, cancer screenings, routine gynecological care, and other preventive healthcare. Your primary care health practitioner will help you manage ongoing issues with blood pressure, sugar, cholesterol, and any other chronic condition. This is also the best place to manage some acute conditions, like coughs and colds, ear, sinus, respiratory and skin infections, minor injuries. I know my patients extremely well, and this puts me in a unique position to discuss with them any number of issues, and coordinate specialist care when needed. Whenever possible, any complaint that is not an emergency can and should be assessed at the office of your primary care practitioner.

The emergency department of your local hospital is equipped to handle more severe health crises, and to admit you for surgical or other serious care if necessary. Some examples: Head to the ER for severe asthma attacks, allergic reactions that affect breathing, significant palpitations, very high or low blood pressure, new or severe chest pain, difficulty breathing, severe abdominal pain, major trauma or injury, severe limb pain, seizure, uncontrolled bleeding from any site (including rectal or urinary), high fever, difficulty walking, moving limbs, or speaking, vaginal bleeding during pregnancy, suicide attempt, mental health crisis, sudden visual problems, severe dizziness, severe burns, suspected poisoning, or broken or suspected broken bones. While I appreciate the faith and confidence my patients place with me, I do not provide immediate blood tests and x-rays, place intravenous lines for hydration, or give intravenous medication. On the other hand, many of us have experienced long waits in an emergency room. Patients are evaluated and seen in order of their severity. There can be surprising and significant costs incurred. And, note that emergency care may be inconsistent, depending on the time of day or which emergency room you use. (Monday tends to be the busiest day of the week, so don’t delay care for problems that arise over the weekend.)

Urgent care aims to fill the gap when primary care isn’t available but going to the emergency room might be unnecessary. They are also well suited for “one-and-done” types of visits. Some examples include insect bites and stings, minor allergic reactions, sprains and strains, coughs and colds, sore throats and earaches, minor eye infections, minor wound care and stitches, minor burns, fevers, vomiting and diarrhea, minor abdominal pains, and painful urination and urinary tract infections. Keep in mind, however, that the urgent care doctor does not know you, will be reluctant to prescribe medication, and may well redirect you to either your primary care doctor or to an emergency room. Services offered by various urgent care centers can vary.

The system is not perfect. Primary care doctors cannot see everyone on an urgent basis, but we do our best to treat and protect the health of our patients. I may receive a phone call with a description of a problem which is unclear, which means that my only safe action is to instruct the patient to go immediately to the emergency room. As a patient, your best bet is to establish a relationship with a primary care doctor, and utilize them as a key component in your health care.