You don’t feel well, have a low-grade temperature of 100.2, achy muscles, mild back pain, mild headache, it really burns when you pee. Emergency room (ER) or urgent care? Not only can the quality of your care depend on what you decide, but also the cost.
If you have a regular physician, then a simple call to him or her may be the easiest and best solution. It’s a Saturday of a three-day weekend and you didn’t get a call back from your doctor, you think you may have a bladder infection, and the local urgent care is right around the corner. It takes you 45 minutes and you are in and out with a prescription for antibiotics and pain relievers. You made a smart decision. It also didn’t cost you an arm and a leg.
Not everyone takes this approach. Someone may have decided it’s best to go to an emergency department at the local hospital. Emergency departments are for just that, emergencies. Mostly life and death, such as heart attacks, major trauma, strokes, and the like. Urgent care centers are urgent care, not emergencies. This could include painful bladder infections, minor burns, sprained ankles, flu-like symptoms, and now, sadly, COVID-like symptoms. Things that need urgent care, but aren’t life-threatening.
A “friend” texted me late one afternoon saying he tripped and fell, scraped a knee, and got a deep cut on his leg but otherwise was fine. He wanted to know if he should go to the emergency room or urgent care. I get a lot of these types of texts from “friends.” I’m not sure why someone would think I can determine their medical needs through a text message.
It’s also amazing how some people lose all of their common sense when they don’t feel well. I told him that he may need stitches and a tetanus booster. I suggested an urgent care center, but it was his decision to make.
Five hours later, I got another text saying he’s in the emergency department of a large hospital and the CAT scan of his head was negative. CAT scan? Really? He decided on the hospital because he “trusted” the doctors there more. They ordered a CAT of his head because he told them he fell to the ground and had a mild headache. Emergency departments tend to do overkill on testing, but that’s a discussion for another time. This friend really just needed to have his leg wound cleaned and get a tetanus booster. He was also really upset when he got the bill several weeks later. I told him that was his fault, not mine.
Urgent care centers tend to be much less expensive than the emergency room for non-life-threatening injuries and illnesses. A Health Care Cost Institute study in 2017 showed an average cost of $1,389 for the emergency room, and that’s just for basic care. That doesn’t include blood tests, X-rays, CT scans, and treatment. Average urgent care basic visits run from $100 to $150-plus.
The Centers for Disease Control and Prevention estimated that there were 130 million visits to one of the 5,200 documented ERs in the United States in 2018. By the way, 43 percent of hospital admissions come through the ER.
The National Hospital Ambulatory Medical Care survey estimates that one-third to one-half of all ER visits are for nonurgent care. The New England Health Institute said 56 percent of emergency room visits were “totally avoidable.”
Some common reasons for ER visits in 2019 were chest pain, upper respiratory infections, urinary tract infections, fever, and trauma.
A few years back, I cut my hand on a fence while we were on vacation in Kauai. My wife is smarter than I am, and she convinced me to go get a tetanus booster. I went to a local urgent care facility, had the cut cleaned, and got my booster. I paid a small co-pay and was in and out within 45 minutes.
A lot of the increase in costs of ERs has to do with patient expectations, excessive billing, and defensive medicine. That’s yet another discussion for another time.
The bottom line is if you have what you believe is a true medical emergency, then by all means go to your nearest emergency room. That’s what they are there for. Time can be critical, such as in a stroke or heart attack. Don’t overthink, just go.
If you don’t have a true medical emergency, then first try calling your doctor, or the one on call.
If you can’t reach anyone, then an urgent care facility may be your best option. Many have extended hours. Most are not 24 hours though. Urgent care centers are usually reasonably priced, quick, and thorough.
To give you a perspective on this from the other side, I work as an ER doctor. One shift, at 2 a.m. the on-call phone kept ringing in my call room, finally cutting through my deep sleep. I picked it up and the ER doctor was on the phone. She didn’t sound happy. She had a patient in the ER, a 45-year-old lawyer who has been waiting for hours and was upset that it’s taken so long to finally be seen. The ER doctor was even more frustrated since she had a full house with real emergencies.
This patient had some cramping and wanted pain meds and something to help her sleep. She brought with her a full “file” of her medical problems, which included recent ultrasounds and lab tests. That’s a major warning sign for an ER doctor. Beware of patients bearing a laundry list.
The patient had endometriosis, which can be painful. She wasn’t able to get in to see her regular doctor and decided to come to the ER since it was convenient and easy. This patient expected the ER doctor to just “read” the notes she brought and give her what she wanted. She said that she had a trial that started in two days and didn’t have time for a full workup of her pain.
I went down to the ER, examined her, and told her she didn’t have a medical emergency and we aren’t a clinic but an emergency department. She didn’t choose to go to an urgent care center earlier since she was “busy.” I gave her a list of urgent care centers that opened in a few hours. I also had an ectopic pregnancy patient rushed into the room next to her which was a true life-threatening emergency. I offered to see her when I was done with the medical emergency. Needless to say, she left, but not as a happy camper. Emergency rooms aren’t for managing basic or even complicated health care problems, but for saving lives during emergencies.
Try common sense when deciding where to go for any medical problem. True emergencies belong in the ER. Urgent issues belong in an urgent care center. It’s really that simple. If you’re not sure, you can always call the ER or urgent care and ask.
One way to tell the difference is to contemplate this quote from an unknown author:
“Always remember that if the weather or the wait time determines your need to come to the ER ... it’s not an emergency.”
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