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Primary Care, ER, or Urgent Care?

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By Natalie Harding & Josh Rosenblum, Grace Cottage Family Health & Hospital

Natalie HardingJosh Rosenblum, PA-CHow do you know when it’s time to go to the hospital Emergency Department versus an Urgent Care Center or to your Family Practitioner?

Josh works in the Grace Cottage Emergency Department, and Natalie sees patients at Grace Cottage Family Health, so together, we have good insights to help patients decide the best place to go for healthcare.

 

Natalie – The Primary Care Advantage:

We both agree that, whenever possible, it’s best to see your primary care provider (PCP). The relationship that develops between you and your PCP is your key to long-term health. No one knows your health status, health history, and treatment preferences better than your PCP. No one is more familiar with your life circumstances and your common stresses. No one has better access to your health records. No one understands the context for your present ailment.

If you don’t have this kind of trusting relationship with your PCP, then find a provider who is a good fit for you and build this. Your PCP is best situated to make complex and difficult diagnoses when there is time to order tests, make referrals to specialists, and develop a comprehensive outlook. PCPs can monitor you and follow up, something not routinely done by urgent care and ER practitioners who see you once and then move on.

Primary care is hard work, and most PCPs are in it because they really do care and because they are relationally oriented. That’s the heart of practicing family medicine. I know my patients’ situations. I have the honor and privilege of being with them in their greatest moments and during some of the most difficult ones, from infancy to death. So, for the best, most-coordinated, highest-quality, deeply-reasoned, cost-effective, long-term, you-centered care, go to your PCP.  If this sounds like a shameless plug for your PCP, it unabashedly is!

Josh – The ER:

The ER is for anything potentially life- or limb-threatening, anything so severe that it can’t wait. If it’s an emergency, don’t go to your PCP, as they will just send you on to the ER. 

We’re here for you when you need it—whenever you have an emergency. Most ERs, including Grace Cottage’s Emergency Department, are open all day and all night, 24/7/365. We are ready to deal with any health condition.

For asthma attacks or COPD, allergic reactions affecting your airway, chest pain, or severe bleeding, call 911 to take you to the ER because you might not make it driving. Also, because your brain is so important, things like stroke symptoms, vision loss, speech problems, paralysis, seizures, mental status changes, passing out, and severe headaches all qualify as emergencies. Unbearable pain, severe dehydration, continual vomiting, significant trauma, and suicidality can also be life and limb threatening and thus warrant a trip to the ER.

The ER can determine what is needed, perform comprehensive work-ups in real time, and address your needs, either then and there, or by stabilizing you and transferring you to a higher level of care, or by arranging for a future outpatient work-up. The ER is a great place, and I love working in this environment.

But don’t go to the ER if you don’t need it. There are drawbacks to the ER. First, your PCP will generally give the best possible sustained care for you. Second, the ER is an expensive place to get your care, regardless of your medical problem. We should all be the best stewards we can be of every healthcare dollar we spend, whether insurance “is covering it” or not.

While people really should not go to the ER merely for convenience, rest assured that the ER does take all comers. When you go to the ER for non-emergencies, you run the risk of waiting a long time because the ER is not first-come, first-served; emergency situations always take precedence.

Urgent Care:

Urgent care centers are growing in number. Their primary value is convenience. They can address urgent (but non-emergency) issues that occur when your PCP’s office isn’t open, and the only other option is the ER. Urgent care centers offer less expensive and faster in-and-out care than the ER for non-emergency health issues. They are good for straightforward, urgent things that come up and don’t need as much long-term care, like sore throats, urinary tract infections, upper respiratory illnesses, ear infections, sinusitis, minor sprains, minor burns, and insect bites.

The downside is that urgent care centers do not have access to your past health history and records. They will only know about possible medication interactions if you remember to tell them every medication you take. They might not know how the current problem fits into the context of any chronic conditions and patterns you have. The providers there won’t have the trust and rapport that you have developed with your PCP. They can take care of you quickly, doing minor investigations of blood work and/or x-rays. But if it can wait, your PCP is the best place to go. If you do go to an urgent care center, you should always inform your PCP afterward to schedule follow-up.

To sum it up, whenever you’re in doubt about whether to seek emergency care, if possible, call your PCP for advice. If, however, you think you need it, don’t hesitate to call 911 or go straight to the ER.