Disease-Proof: Boost Your Health for Lasting Well-Being

Additional Info

• Segment Number: 4
• Audio File: ER_101/1524er5d.mp3
• Featured Speaker: David Katz, MD, MPH, FACPM, FACP
• Organization: Huffington Post
• Book Title: Disease-Proof: The Remarkable Truth About What Makes Us Well
• Guest Website: Dr. Katz
• Guest Bio: David L. Katz MD, MPH, FACPM, FACP, earned his BA degree from Dartmouth College (1984; in three years); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993).
  
  He completed sequential residency training in Internal Medicine (Norwalk Hospital, CT; 1991), and Preventive Medicine/Public Health (Yale University School of Medicine; 1993). He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He received an Honorary Doctorate (Humane Letters; L.H.D.) from the University of Bridgeport in 2013; and will receive a second honorary doctorate in 2015.
• Transcription: RadioMD Presents: Dr. Leigh Show | Original Air Date: June 12, 2015
  Host: Leigh Vinocur, MD
  
  RadioMD. RadioMD.com. It's time for ER 101, in conjunction with the American College of Emergency Physicians. Here's Dr. Leigh Vinocur.
  
  DR. LEIGH: Hi and welcome back to our ER 101 segment. My next guest, a frequent guest of the show ER 101, Dr. Ryan Stanton, emergency physician at Baptist Health in Lexington, Kentucky, and he's the recipient of ACEP's 2012 National Spokesperson of the Year Award. So, welcome back, Dr. Stanton.
  
  DR. STANTON: Thank you.
  
  DR. LEIGH: The question is – and I see it time and time again (and I have to say I've worked in both ERs, urgent cares) – where do you go? People don't often know. They're popping up everywhere because they are filling a void. There aren't enough primary cares. If you call your primary care with a problem that's bothering you that's kind of urgent, they say, "Okay, come in two weeks from now." [laughing] So, they are popping up everywhere, but sometimes people don't really know what is the difference and when they should go where. There was a recent poll ACEP had, correct? That discussed a little bit of this.
  
  DR. STANTON: Absolutely, released recently a poll that talked to emergency physicians about their experiences with urgent treatment centers, basically on the receiving side. And the most important thing for listeners in terms of the lay public to consider, is that urgent treatment centers are on the continuum. They're a valuable aspect of the health care family, but on the continuum based on what your needs are. Urgent treatment centers are basically that. Urgent treatments for things you can't get in to see your primary care doctor.
  
  Basically what I tell people is if you know what's going on and you know it's an easy fix, even as the lay public, then consider an urgent treatment center. But if it's considered a potentially could be an emergency – anything chest pain, anything abdominal pain, anything significant headache or injury – then you need to go to an ER, because all that happens if you go to an urgent treatment center with something that gets upgraded in terms of severity is you get billed twice because you go to the urgent treatment center and then you get sent to an ER.
  
  And I see that all the time in the emergency room. I kind of feel bad for the patients because they've already put out money for one visit when if they had come to me to start with, we would have knocked out everything we needed to do right away. So, the most important thing for patients is to just be aware that urgent treatment centers are for minor things but if you have a significant emergency, you need to go to an emergency room.
  
  DR. LEIGH: Right, and even though, what people don't realize is okay, you know, your bellyache, it could turn out to be nothing. But at an urgent care where they don't have things like – I mean many urgent cares that I worked in didn't draw any blood. You couldn't tell if a person had an elevated white count indicating an infection from their belly pain. And maybe they have an x-ray, but they don't have a tool to really look at the abdomen like a kid with a bellyache and an ultrasound. So, even though you might end up with the ER or if you go to the ER first and it turns out that your bellyache is nothing, it's still something that needs to be assessed, correct?
  
  DR. STANTON: Yes, and your thought needs to be "Can my problem..." or "Do I think my problem..." or "Am I confident that my problem...can be fixed at an urgent treatment center?" If that answer is "no", with the example of belly pain, it could be appendicitis. It could be cholecystitis. It could be a lot of things. Chest pain could be pneumonia. It could be a heart attack. It could be a blood clot in the lungs. If the urgent treatment center isn't the place that is going to fix the problem, don't go there to start with, because they are limited. They are limited in terms of their lab capabilities, imaging capabilities.
  
  Most importantly, if there needs to be some sort of referral, admission, or intervention, they may not be the best group. Simple lacerations, ankle sprains, cold symptoms, allergies, things like that are wonderful types of visits for an urgent treatment center. Walk in, easy fix, easy evaluation, and then out the door. But more complex – especially chest, abdomen – needs to be head on to the emergency room.
  
  DR. LEIGH: I like the way you say if you think you have a little idea of what it might be. Like, okay you have a cold and, I have to say, even bronchitis in young healthy people now, we do treat them outpatient with pneumonia, and you can get x-rays at most urgent cares. But if it's beyond that and you're not a young healthy person, that's another thing to think about. Right? Because a young healthy person that might end up with pneumonia could maybe be treated as an outpatient. But if you're an older person on multiple medications, other lung problems and you have pneumonia, that's a whole different story.
  
  DR. STANTON: Right. Well, a good example around where I live is – Kentucky is still the number one in the country for smoking. We have the highest number of smokers in the country and so we have a lot of COPD and emphysema. COPD and emphysema increases that risk significantly with pneumonia, complications, resistant infections, even death-- hospitalization and death. That group is much more at risk than the 22 year old-- a person who works out, athletic person-- who has a little bit of a viral pneumonia. So, it's completely different how they are treated. And true, many things that we are going to see when it comes into the emergency room that could potentially be dangerous – abdominal pain, chest pain – aren't necessarily going to be admitted or have to have surgery.
  
  But I would rather have you there at that emergency room where I can get things done if you need to be admitted or a surgery, as opposed to somewhere else and having to have you transferred again and then having the evaluation completed and then get that done. That delay in care may make a difference in terms of your course, any type of complications, the type of surgery. Abdominal pain with the appendix being a big issue. If you're delayed a couple or a few hours, it could mean a ruptured appendix. That's a very different course than a simple appendicitis. So, those are things to consider.
  
  One of those things where I think that patients have a good opportunity to know for sure – I mean everybody's going on Google and getting health advice, the Google doctor, Dr. Google, he's doing a lot of diagnosis – and so if it's an easy thing, yes UTC, but if it's not, if it's more complicated due to high risk factors, get to the ER.
  
  DR. LEIGH: Okay. So, actually, I'm going to give you one or two scenarios and then you can explain to me why and what do you think.
  
  So, I have a one-week-old that has a fever of 100.6. ER or urgent care?
  
  DR. STANTON: ER. That is no question. As soon as you say "one-week-old", that's ER because one-week-old, with fever, no matter what the rest of the story is, is a high risk for significant infection and it's going to be admitted. It's going to be a full septic work up, meaning lumbar puncture, culture, labs. That needs to be an ER, because that's a high-risk population. You kind of delved into it earlier: high-risk populations need an ER because there are special considerations and special things we have to do. Three months later, six months later, different story. But one-week-old goes to the ER.
  
  DR. LEIGH: Okay. How about a 15-year-old was playing football, came up from the bottom of the pile, could sort of barely walk, his ankle and hip are hurting him.
  
  DR. STANTON: That one's one that can probably be okay for urgent treatment center, unless you can see a bone. Now, if you stand up or he gets up and you can see something sticking out that's supposed to be on the inside, then that's somebody that needs to go to the ER because that requires antibiotics and surgery. But if he can walk on it, has some pain in a joint, that's an urgent treatment center. If it's more serious, they can transfer over. But the vast majority of those are strains, sprains and those sorts of things, they can be handled at the UTC.
  
  DR. LEIGH: One last – we just have one minute – 84-year-old on six different medications including beta blockers, calcium channel blockers, woke up and their neck feels a little stiff and their shoulder's hurting them.
  
  DR. STANTON: You want to throw in a little chemotherapy and blood thinners in there too? [laughing]
  
  DR. LEIGH: [laughing]
  
  DR. STANTON: Yeah, that's absolutely an ER patient. That person is high risk. That's one of those people that when we walk in the room, we're nervous. We're assuming something terrible is going to happen, even if it is likely benign. But that's somebody that's a very complex situation, special consideration, high-risk for bad things to happen. So, that needs to go to an ER, absolutely.
  
  DR. LEIGH: Yeah, I agree with that. I think the elderly population should not be allowed to go to an urgent care just because with so many confounding factors and variables and things you need to check, there aren't a lot of urgent cares that can do that extensive work up. I think it's interesting, people think ER doctors don't believe in urgent care, but we do. A lot of ER doctors do work at urgent cares, but people have to know what they're good for. I agree with Dr. Stanton. They have a role in today's health care scheme, so I want to thank him for being on the show.
  
  This is the Dr. Leigh Vinocur Show, it's Health from the Outside In, on RadioMD where feeling good starts with looking good.
• Length (mins): 10
• Waiver Received: No
• Host: Leigh Vinocur, MD