5mo ago

How do I know if a medical issue should be addressed by a Clinic Visit, Urgent Care, or the Emergency Room?

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.

63 comments

- Great criteria. Another "straight to the ER" one is loss of consciousness; people get knocked out in movies all the time so it's easy to assume it's fine, but it's not.
  
  I work in 911 dispatch, it drives me nuts how many people lose consciousness for various reasons, and then when they come to they say they're fine and don't need to be checked out.
  There's maybe some very narrow exceptions for people with known conditions that they're already managing with the help of a doctor and they know exactly what's causing it.
  But in general, if you're losing consciousness that's a bad sign and you need to see a doctor about that ASAP

You got the right idea. Heart problems are a bit of a mystery until you can get an EKG done. Urgent cares aren't usually equipped to do more that that. If it's ongoing, maybe look for a cardiologist. But if you're having any sudden shortness of breath then you might need to head to the ER.
- It's just the palpitations and I'm willing to bet that it's going to just wind up being something stupid like a potasium deficiency or something. But thats a good point, I could just go get an EKG done and rule out an impending heart attack then make a clinic appointment for this issue. It just sucks having to pay for two visits.
  Also it's just anoying because this isn't the first time I've been stuck in the department decision paralysis. The last time I wound up going to urgent care and then immediatly having to go to the ER for a damn gall stone that had aparently been an issue for months by that point. Once again having to pay for 2 visits when I could have just gone directly to the ER.
  
  Do you have a primary care physician? I think this going on for 2 weeks warrants talking to them about it. If it’s not changing, then the urgent/emergency need isn’t there. Getting to a specialist could be months or over a year though (took me 10 months for first-available appointment with a cardiologist who specializes in dysautonomia issues like I have; someone I met in the waiting room waited closer to a year and a half).
  Alternatively, if you have insurance many of them have a nurses line you can call and get input. Like you mentioned you would do as an EMR, they’re likely going to recommend you go to the most extreme care (ER) because they don’t want to risk being wrong. But they might be able to talk you through your doubts. And hey, if it’s insurance they have motivation to get you to the cheapest care possible, so maybe they wouldn’t recommend ER after all, lol.
  Lastly, since you’re stuck in decision paralysis, it might be worth taking some actions on your own to see if you can improve the situation. Obviously this isn’t the smartest option, but I know I’m stubborn, cheap, and have white coat anxieties after being dismissed for my health issues my entire childhood, so I tend to go this route often. (Heck, I waited until my mid-30s to seek care that ended me with a cardiologist despite having the symptoms literally as long as I can remember.) You mentioned potassium deficiency and my immediate thought when reading “palpitations” was electrolytes as well. If you have a history of high blood pressure ignore this, but if not, eating salt and getting magnesium/potassium can help a ton. My cardiologist insists I eat 7-10 grams of salt a day. It’s a fuckton, but hell if it doesn’t make me feel worlds better.
  ETA: I just want to reiterate my last idea above is a bad suggestion. But I know that’s likely what I would do, so I mention it anyway. Also I had frequent palpitations throughout my life as some of the symptoms I ignored, but I didn’t actually know those were “palpitations.” I thought “my heart is just beating hard/fast today,” and that palpitations meant something…else. It was less than a year ago when I learned it just meant awareness of your heart beating, and I can’t even explain what I thought it meant before that, other than more than that.
- Urgent care 8snt typically a good place to go to for possible heart issues at all, actually. Some d9nt even keep an ekg machine on hand.
  
  That's why I said usually. EKGs are common where I'm located, might not be the same in your area. It's not that hard to read an EKG, even I could tell you whats normal and what's fucked.

- Yeah, and that's exactly what I'd tell a patient. But it's just anoying when it's me and I know that it's almost certainly going to be something dumb like a potasium or iodine deficiency or something like that. Like I logically know you're right though, this does fit into the "cardiac symptom" = "go to ER" formula.

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.
- 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.
- 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.
  
  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.
- 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.
  
  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.

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.
- I drove myself to the hospital while having a heart attack in 2018. About 45 minutes after I arrived I had a stroke.
  
  That's insane. If it doesn't bother you, how did it feel? How long was the drive? What happened afterwards?

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.)

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.

This is why healthcare in the US sucks.
A wealthy person will have a 24-hour hotline to connect with a nurse or doctor (immediately or through return call) with access to their medical history who will help them figure out what to do.
A moderately well-off person will have a web/phone interface where they can send a message and someone will return their message in a day or two.
Everyone else has to make a gamble: do I spent money to try to figure this out? Do I risk spending money and then it turns out to be nothing? But what if it's something and it's more expensive later on? What will my insurance pay for? How do I find someone that's reliable, but also inexpensive? All of this causes stress which makes things worse.
In your case, think of anyone who knows your medical history and who you can ask questions of. The doctor who prescribed your anxiety medications - can you call/message them and ask them? The pharmacist who dispenses the meds - can you go/call and ask a question about your medications? Some pharmacies also have nurse / clinic stations, too. If you have any kind of medical insurance, check out their web page - a lot of them have set up tele-medicine offerings recently. If your job has an HR department, this is actually one case they can be helpful; an HR person in my company helped me figure out what health resources I had access to, based on my plan. Finally, if you haven't been getting annual checkups, you should start thinking of doing so (especially as you get older), and ask them how you can contact them to ask questions like this.
Good luck fam, I hope it turns out OK for you.
- Yeah, my area used to have a really good public nurse line where you could just call in, tell them what was going on, and based on your medical history on file they could roughly triage you and tell you where to go. But I imagine keeping it running was cutting into the hospital exec yacht fund so they cut that service.
  I could always message my primary care doc but normally I just catch one of the nurses and they just tell me to make an appointment. Considering my primary care doc is always booked solid 6 months out I almost never bother going that route unless it is for an anual exam or something. My meds are just through a chain pharmacy so the pharmacist won't know much about my particular situation. Someone else had mentioned insurance offering telemedicine too so I will definitely be looking into that one. I also happen to be on the medical response team at work so I am intimately aware of what our offerings are for healthcare options (practically nothing). Also I am 100% on the regular checkup train. I will ask my doc if there is something to fill the place of the old nurse line at my next checkup.
- There's a hospital very close to my house. Less than 2 minutes away.
  Twice we've driven there (the person driving did not have the issue in question). Both times it turned out ok, but everyone at the hospital felt the need to lecture us that we "really should have called for an ambulance".
  I said wow, you guys really want that $2,000 taxi fare for nothing.
  There are definitely times when you should call for an ambulance. But it enrages me when you know it's only about the fucking money, but they give you the concerned sanctimony attitude.

Clinics are when you can call ahead to make sure they can handle your issue that can't wait for a GP appointment. Your burning genitals or deep cut will be seen at their earliest convenience. They can be used for GP services if you do not have a regular care provider.
Hospitals are for when you were referred there, have an on-going issue, or no clinics are open. You are not in urgent need of medical intervention, or are man enough to die in the waiting room with your 104° fever and almond smelling cut you got from a fence two weeks ago that has dark veins radiating from it because "it's nothing, just a cut". You can use them for typical GP services if you don't have a regular care provider and many offer clinic services.
GPs are for regular checkups or visits for something you are concerned about.
ER is for when dispatch calls ahead for you, severe pain, severe injury, unconsciousness, or OD. Expect to wait for hours if you are conscious and not leaking, because others are and you aren't the main character today.
- Thank you for answering the base question and not giving medical advice.
  or are man enough to die in the waiting room with your 104° fever and almond smelling cut you got from a fence two weeks ago that has dark veins radiating from it because "it's nothing, just a cut".
  How do you know my dad?

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.

If you have insurance, they typically have a hotline you can ask about stuff like this.
- Ooh, that's a good idea. I'll have to go check on that. Thank you. I knew our local nurse line was dead but I didn't consider that my insurance may have one.
  
  Your insurance should have a nurse line. If not, your company likely has a employee assistance program (EAP) that might be able triage.
  
  If you in the US, you're primary care doc's office wil havel an after hours number to call if you're not sure. Unfortunately you'll likely be told to go to the ER if it's heart related because we have to err on the side of caution since we can't evaluate you very well over the phone. Urgent cares are hit or miss since they're staffed mostly by mid levels who may or may not be well trained but they can handle sore throats/colds, simple cuts/infections/foreign objects, STD testing, etc. depending on their facilities. I've been to one without basic labs which is crazy. I'd suggest calling you doc's office first to see if they have acute visit slots that day. A lot will.
- Ours is through our provincial healthcare system, but the service might be similar for you depending on where you're located:
  https://www.healthlinkbc.ca/more/about-healthlink-bc/about-8-1-1

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.
- That's a good point, when in doubt urgent care can at least rule out anything immediately concerning.

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.

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.
- 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

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

Depending what county you live in, etc. There are nurse hotlines that you can call. That said I've never used them.
- We used to have one in my area but they stoped doing it a while back I'm assuming just because it wasn't making anyone any money. Can't just do something solely for the public good after all.
  
  That’s infuriating, I was going to recommend that. It gets cancelled because it doesn’t make money, but it saves so much money by preventing people from using a higher acuity of care than they need.

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.

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).

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.

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.

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).

If you can drive, drive to the hospital. Ask the person at the front desk what they would recommend. If they recommend the ER, then at least you didnt have to make that decision. That being said, I do not nor have I ever worked for a hospital, but ive been a patient quite a bit.
- Unfortunately for me the nearest real hospital (the local one is just a malpractice factory) is a 45 min trip 1 way so I can't just swing in in person too easily. They used to have a nurse line you could call and ask questions like that but they got rid of that like 5 years ago.

It comes down to what's open, how dangerous the condition is, and who was outfitted to do what.
If you're having legitimate trouble breathing like you are filling your lungs and it's not enough, or you can't get enough air in your lungs for any reason, straight to the ER.
Unknown irregular heartbeat or chest pain that doesn't go away with antacid, go to the ER.
Urgent cares near me generally have x-ray equipment. They're capable of a few stitches, they can handle prescriptions for emergent illness. If you walk in there with a f'dup heart rhythm or breathing problems they're going to call you an ambulance.
Scheduling something with your primary care is for all your other long-term needs. Preventative maintenance, blood tests, they can probably do an EKG and they should be the ones managing your long-term medications.
If you have something that feels urgent and the urgent care isn't open the ER is always an option.

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).

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.

Here in BC you can call 811 to talk to a nurse and get advice on things like this, maybe your state has something similar?
- We used to have a nurse line but they stopped doing that like 5 years ago probably because it wasn't lining anyones pockets.

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

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.

63 comments