It is 5am, and you have been vomiting constantly for over 4 hours. Do you rush to the Emergency Room (ER), or do you wait and go to an Urgent Care (UC) facility at 8am? The choice may seem simple but there are factors to consider that will dictate the most appropriate location to receive the best care. If you have been vomiting the food that you ingested last night from a backyard barbecue or a fast food restaurant, then an Urgent Care is the best place to handle your current condition. However, if you are vomiting blood, it is imperative that you go directly to the Emergency Room. During this age of instantaneous information, individuals often find it difficult to spend hours sitting in an ER waiting to be evaluated. Others do not want to go to the ER and often prefer an UC because of the high cost associated with an ER. Also, some people refuse to travel via ambulance to the ER, even when it is deemed in their best interest to do so, due to cost. With the rise of so many Urgent Care facilities, which were born out of a need to stand in the gap between the Emergency Room and the Primary Care Providers (PCP) office, the UC is often seen as a convenient choice to save both time and money. But does the UC fit the needs of everyone needing urgent or emergent healthcare? Unfortunately, the answer is no. The UC will not be able to service all needs and there is still a role for the ER to play. The UC model was designed to relieve the pressure of an ER overrun by conditions that can be handled outside of the ER. For example, a sore throat with a mild to moderate fever (Temp= 99.1 to 100.9) has no place in the ER. Visiting the ER with a sore throat will cost you time and money which would be dramatically less had you gone to an UC. However, if you are experiencing a sore throat with a narrowing of your airway and have difficulty breathing as a result with or without a high fever (Temp=101-104), please proceed to the nearest ER immediately. The difference in the location of care is often determined by the severity of your symptoms. It is important to know where to go to access the best healthcare for yourself which can save time and money. From a clinical standpoint, as an Urgent Care Physician, I am poised and ready to assist you with your healthcare needs and remain equipped to handle a host of conditions: simple fractures; sutures; upper respiratory infections (bacterial or viral); atypical chest pain (ribs or musculoskeletal); sore throat; allergies; sinusitis; sexually transmitted infections; abdominal pain; dizziness (vertigo); and motor vehicle accidents (without head injury). However, I cannot and will not be a replacement for the ER. If you are having slurred speech, facial droop, mental confusion, and/or an inability to move a body part, go to the ER immediately as these are signs of a potential stroke in progress. Time is brain tissue! If caught within a 3 hour window, meds can be used to try to eliminate a clot and reduce symptoms post stroke. If you are having chest pain or shortness of breath, and have had cardiac or severe pulmonary issues, go directly to the ER and contact your Car14
Inside Medicine | winter 2016
diologist/Pulmonologist. Time is heart tissue! You have a better chance of survival from a Heart Attack (MI) if you go to the ER and get diagnosed and treated within 6 hours. Pulmonary Embolisms (lung clots) may not give you hours before your ultimate demise. If you visit the UC with cardiac chest pain, you will likely be sent to the ER. This approach will cost you time and money as you will be charged for the visit to the UC and then charged again at the ER. Even if the UC is equipped with tools to identify a cardiac event or the possibility of a clot in the lungs, the office is not equipped to handle these emergencies in the UC and will have to send you to an ER directly. In addition, your mode of transport will become costly as it is likely that an ambulance will take you to the ER as it is unsafe to drive or even be driven to the ER due to your condition. The only way to avoid transport via ambulance is to sign your life away via an Against Medical Advice (AMA) form. The AMA form is a costly venture as well in that it places your life and your healthcare consequences in your hands and relinquishes the physician caring for you of all accountability. I recall pleading with a few patients to go to the hospital via ambulance in an effort to save their life only to have to discuss and fill out the AMA form and pray to God that they survive the journey and get the advanced level of care that they require in time. In addition, while Urgent Care physicians are equipped to handle acute healthcare issues that can be taken care of by the Primary Care Provider who may not be present in the office, we are not a replacement for your PCP. We often work on shifts and work different schedules and in some cases different offices at any given point and time. Therefore, we will not be the best option for managing your continuity of care if you have serious chronic illnesses that require monitoring. But we can stand in the gap for your PCP, if they are out of the office or unavailable to you, to handle any Urgent or Primary Care needs as they arise acutely. While UC physicians are equipped to handle most acute care needs or even PCP tasks, we cannot be a replacement for the ER and should not be accessed for serious illnesses or conditions. So, if you have chest congestion and difficulty breathing or a cough and cold symptoms, stop by the UC for treatment, but if you have acute shortness of breath and/or chest pain associated with extreme fatigue, go to the ER immediately. If you have acid reflux, stop by the UC, if you have right lower quadrant abdominal pain and your appendix is still in, go to the ER immediately. If you have dizziness along with an ear infection, stop by the UC, but if you have dizziness with new onset of a severe headache that woke you out of bed and felt like a thunder bolt exploded in your head, go to the ER immediately. As a Family Practice Physician who is now practicing solely as an UC physician, I pray that this article allows you to prosper and be in good health, but when this is not the case, I hope that you will access the appropriate location for the level of care you require. by Marcia Mierez, DO | Highway 53 Urgent Care
