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 it’s bugging you not knowing and you don’t want to wait until your clinic appt, then yes, urgent care would be able to at least tell you if it’s an emergency cardiac event and send you on to the ER, or if it’s something like afib and it can wait to follow up with an office visit.
Afib, which commonly causes palpitations, should be seen in the ER if you can’t get in to your PCP that day. Could be caused by a lot of things and a work up is warranted including lab work, echo, etc if new.
Very good points. I based my comment on a personal experience with family, and they were not endangered by waiting a few days to see a cardiologist. I didn’t know there could be other causes that are critical enough for the ER. But I should have guessed because I know it is similar with tachycardia. Sometimes someone’s had too much Red Bull, and sometimes it’s a birth defect in the nodes in the heart and heavy sedatives are needed to calm that down.
Oh yeah, a lot of common causes need to be evaluated plus we need to assess if the person should be on blood thinners due to the risk for a clot in the heart that can travel to the brain. I’ve admitted quite a few patients for new onset Afib due to their underlying causes as we didn’t think they were good to go home. Admittedly most people would be fine and we can be too cautious due to legal liability and physician anxiety over bad outcomes but considering the possible consequences, it’s not a terrible thing to do that.
That’s a good point, when in doubt urgent care can at least rule out anything immediately concerning.