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Urgent Care vs. Emergency Room?

It’s 10 o’clock on Friday night and you felt a little ‘off’ today. A little achy. A little tired. But it was Friday and the weekend would take care of everything. But now it’s late, your doctor’s office has long ago put the message on the answering machine that says, “Sorry you’re sick. Call 911 for an emergency, otherwise, suck it up Buttercup.” Unfortunately it feels like a demonic parrot with a handlebar mustache is trying to peck its way through the back of your throat. What are your options if you don’t feel like suffering in silence?

In the old days, your only other option was the Emergency Room. In the old, old day, you had to dispatch a farm hand to roust the doc in the holler to get in his buggy and hope the crick was fordable. That is why mortality was high. Today we have a variety of options to choose from including an Urgent Care, Walk in Clinic, Telemedicine, Doctor Google, Pharmacist and Aunt Mildred. We will discuss the pluses and minuses to choosing an Urgent Care vs an ER. I don’t have the space to address Aunt Mildred.

On the plus side, Emergency rooms are accessible, open, and capable of handling nearly any level of illness. They are staffed with highly trained personal around the clock with the latest and most expensive equipment. They deal with heart attacks, strokes, fractures, internal bleeding, meningitis, pneumonia, blood poisoning, and many other serious health conditions. However, maintaining that level of readiness and equipment is very expensive and you, and your insurance company, will pay for it.

ERs tend to have higher cost, longer waits, fragmentation of care, and possible over treatment. The average cost of an ER visit for sore throat is around $600 vs. $100 for an Urgent Care visit. Plus the wait can be long if you are not judged to be an emergency by the triage nurse and the ER will likely not have any access to your records, history, or allergies other than what you can remember off the top of your head. Also, doctors tend to err on the side of caution so we’re more likely to run tests and prescribe medication if we’re unfamiliar with the patient. This can result in well-intentioned overtreatment.

On the plus side, Urgent Cares can provide faster, cheaper service for less life-threatening problems. But they also suffer from care fragmentation and, since many are run by businesses with stakeholders expecting profits, there is a greater incentive to over-test to improve the bottom line. Without any ongoing relationship with a patient, many retail clinics fear of being sued which drives up tests and costs. The best option is an Urgent Care or extended hours clinic run by your Primary Care practice which is becoming more common.

So where should you go? There is no one catch-all answer but the best general guideline is the Prudent Layperson Standard. This states that “Any medical or behavioral condition that would lead a prudent layperson, possessing an average knowledge of medicine and health, to believe that the severity of their condition would result in death or harm to a physical organ.” So if a reasonable person thinks their life or a limb is in danger, they should drive by the Urgent Care to the ER. Insurances are starting to use this standard to deny some visits to the ER.

Your demonic parrot is best removed at an Urgent Care. Your chest pain, trouble breathing, broken bone, severe tummy pain, crossbow mishap is ER material.

Dr. Chris Ward

Is a local physician trained in Mechanical Engineering, Pediatrics, and Internal Medicine