ER, Urgent Care, or Primary Care: Which Should You Choose?

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When a senior develops an urgent medical need, it can be difficult to know where to seek treatment, especially due to their often complex health history. In some cases it might be best to call their primary care physician (PCP), but in others, a trip to the emergency room may be in order.

As medical director of MyCareClinic at The Carlisle Naples, a senior community offering both independent and assisted living in Southwest Florida, and an urgent care physician at ER QuickCare, Dr. Carlos Paisan is no stranger to the complex medical decisions that seniors and their caregivers navigate on a daily basis.

Deciding where to seek care can be tough, and “if you make the wrong decision,” says Dr. Paisan, “you’re going to bounce around from one care setting to another. The more you bounce, the more physicians you will see, and the higher the likelihood that mistakes will be made.”

Below, Dr. Paisan offers guidelines to help caregivers determine which situations necessitate a visit to the hospital, which can be handled at an urgent care center, and which can wait for an appointment with a PCP.

Matching Medical Needs with Options

There are generally three options for urgent medical care: the emergency room, an urgent care clinic, or your primary care physician (PCP). Each setting is appropriate for different situations since they provide different levels and types of care on varying time frames. The first step in this process is determining the acuity or severity of a senior’s condition.

Emergency Medical Issues

The most critical health emergencies should always be dealt with by calling 911 and getting the senior to the emergency room as quickly as possible. Hospitals provide the highest level of care and offer a comprehensive array of specialty health services.

“There are a couple of instances with medical conditions where time makes a huge difference” explains Dr. Paisan. “Time means cells that are dying, and the quicker treatment is received, the better.” Suspected cardiac events, like heart attacks, stroke, and shortness of breath in patients with COPD or asthma all require substantial testing and have windows of opportunity for proper treatment.

Dr. Paisan provides a few sample questions that can help caregivers determine the severity of a senior’s condition:

  • Are they so short of breath that they can’t talk in full sentences?
  • Are they having chest pain or abdominal pain?
  • Is the pain so bad that that are having difficulty walking?
  • Are they able to keep any food or liquid down?
  • Have they fallen?
  • Are they capable of getting up or bearing weight?
  • Are they confused or disoriented?
  • Are they experiencing muscle weakness on one side of the body?

It is always best to err on the side of caution. Many seniors are reluctant to call 911 because it can be an embarrassing ordeal, but “if any of these symptoms are present, these are not times to be shy,” notes Dr. Paisan.

Since hospital emergency rooms are open 24/7, they may be the only option available, regardless of how significant a senior’s medical needs are.

Urgent Medical Issues

Moderately acute health care issues require treatment within 24 hours (i.e. sooner than you can typically get an appointment with a PCP) but are not considered medical emergencies. These can easily be handled at an urgent care or walk-in clinic. Examples include minor injuries and ailments, such as cuts requiring stitches, sprains, low-grade fevers, ear infections, simple fractures, colds, UTIs, flu and other common viral infections.

Basic diagnostic testing is usually available onsite for things like strep, flu, UTIs, and blood counts, but Dr. Paisan reminds caregivers that not all urgent care clinics are the same. “MinuteClinics, for example, are going to have limited testing capabilities, and nurse practitioners and physician assistants providing care. Other clinics can handle more complex problems because they have their own labs, x-ray capabilities, and physicians seeing patients.”

The main benefit of this intermediate option is that urgent care clinics are open beyond typical business hours, including evenings and weekends. However, their availability is still limited compared to that of ERs. If a senior needs stitches at 7:00 on Sunday night, it isn’t likely that an urgent care clinic will be open. Even though their condition isn’t critical, it is time-sensitive. The window of opportunity for closing a cut is about 12 hours, according to Dr. Paisan, so seeking a higher level of care (ER) is a must.

Routine Medical Issues

The most basic, yet personalized, care is going to come from a senior’s primary care physician (PCP) since they have built rapport with their patients and have access to their medical history. Unfortunately, family doctors’ limited hours and appointments mean that they can’t usually be accessed on short notice. A senior may be coming down with a sinus infection, but if you can’t get them an appointment until next week, an urgent care clinic is the next best option.

Caregivers should inquire about the PCP’s policies for appointments. “Ask if you can get same-day or next-day appointments. A lot of PCPs who are with bigger groups have a dedicated doctor set aside to provide same-day care for the onset of unexpected illnesses. This makes makes life a lot easier,” Dr. Paisan notes, “because the patient’s medical records are accessible, and everything is in one place.”

Making an appointment with the family doctor, their nurse practitioner, or their physician assistant is ideal for relatively mild issues that do not need immediate treatment. For example, if you suspect your loved one has the beginnings of a urinary tract infection (UTI), you think their medications may need to be adjusted, or they are showing early signs of the flu, a cold, or pneumonia, then make an appointment with their PCP.

Establishing an Emergency Plan

As people age, minor injuries or illnesses are more likely to evolve into health emergencies. Communicating with a senior’s doctors, achieving a thorough understanding of their health conditions, and researching options for medical care in the surrounding area will help to ensure you make informed decisions at critical times.

Assemble an emergency medical packet containing all of your loved one’s important medical information. Bring this folder with you on urgent care or emergency room visits to help give care providers a more complete picture of the senior’s overall health, both past and present.

Research local hospitals and urgent care clinics to see what their specialties and capabilities are. Consumer Reports rates many hospitals by state, but overall ratings can be hard to find. Best Urgent Care Directory offers listings and customer ratings, and individual hospital reports are available online through Medicare’s Hospital Compare tool.

“Healthcare is very specialized these days,” Dr. Paisan emphasizes. If a loved one has heart disease and is at high risk of having a heart attack, for example, ask their PCP for a recommendation or look for a local hospital with a cardiac catheterization laboratory onsite in addition to general ratings and reports.

Ask questions and communicate clearly with a loved one’s primary doctor before an urgent situation arises to prevent complications and confusion when trying to decide where to seek treatment. At routine visits, family caregivers should run a few of the most likely medical scenarios by the PCP to get their input on what symptoms to take seriously and where to obtain care. Dr. Paisan encourages these what-if conversations so that the entire care team can devise a couple of basic rules for pressing situations that are tailored to the senior’s conditions and take their health history into account.

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8 Comments

Your right about the primary care doctor..can't see in ER or even if admitted to hospital there is a hospitalist doctor who oversees your care. This has happened where they observe & send your loved one home or observe & transfer to floor in hospital. You still don't get to see your regular Primary doctor. The fire dept. as well as the EMT unit comes out..they intimidate you by asking over & over what you want to do...take loved one to ER????We've also found that if you just want to be checked out in the ER & their not too bad...have the Fire dept & EMTs put them in our vehicle & go to drive thru at ER but still you may have to wait. Plus all the paperwork that has to be filled out before you can even get back to the room where your loved one is. Be sure you have all these papers ready & available at a moments notice. Ambulance is around $800 to $1000 (less your deductible depending on your insurance) plus if you are transported back via ambulance it is about half that cost plus the city bills you for some service for other entities that show up. It is months before all these bills come in. My Dad passed in April, 2015 & it is Feb, 2016 & still receiving bills for him. Once again a decision about whether to move my Mom from AL to her home. I will run into primary care doctor?, ER?. In AL they wear a necklace that can be pushed & someone from the AL comes & checks before 911 is actually called. If they hit their head, you have to go to the ER. Now, I have a company where a NPractioner will make house calls to the AL for illness but it all is a hassle. Paperwork, multiple phone calls always staying on top of all these service folks as well as your loved one. In most cases the loved one does not understand. My Mom has been out of it for almost a year & has just started realizing what is going on but I see so many with dementia that don't understand & are expected to take care of themselves to some extent. Very sad. Some family members don't even show up when they are sick or have to go to the hospital. Good Luck.
My mother is 93 years old and housebound. She has had upper respiratory tract infection for a few days and called her primary (does not see her unless she goes to hospital but refills meds monthly). Doctor called pharmacy with RX, however, pharmacy said it would interact with current meds so they would not dispense. Pharmacy called doctor with 3 alternatives but doctor did not respond to pharmacy and the office is closed today. How can we find a doctor that will make house calls for my mother....She lives in 14094 zip code? At her age this could be fatal.
Excellent article on this topic! Although I would have to quibble with ProPublica. Whether traditional hospital or HMO, I think only once have we gotten in to be seen in only half hour or so. Generally 1-2 hours to get seen, and once in, another 1-2 hours for our experiences. I'm just glad our states (mine and other family members) aren't on the longest wait times. :)