Transcription:
Know Where to Go: Urgent Care vs. ER

Melanie Cole (Melanie): All too often, illness or injury appears out of the blue. It happens for all of us, but how do you know when to go to the emergency room, whether it's truly an emergency, or whether you can go to an Urgent Care clinic. My guest today is Dr. Stephanie Marzola. She's a family medicine physician with BayCare Health. Dr. Marzola, let's start with a little difference between the walk-in clinics, Urgent Care, and the emergency room. What's the difference between them?

Dr. Stephanie Marzola, MD (Guest): So I would say the main difference that you're looking at is kind of right in the title. So one says 'emergency,' and one says 'urgent' or 'urgency.' So when you're looking for an ER or an urgent care, the main difference is going to be- I would say whether it's something emergent like you can't breathe, you're having horrible chest pain, you fainted, you were in a bad car accident, versus like an urgency, which is, "I'm sick and I'm not getting better, and I can't get in to see my doctor." "I twisted my ankle at the soccer game, I really need to make sure it's not broken for tomorrow." Those kinds of things as far as why you would go.

But as far as kind of what that looks like, an emergency room is obviously usually connected to a hospital, so you kind of know the hospital facility, and they obviously have more resources. And the Urgent Care usually is free standing, sometimes it's with a health system, sometimes it's like a private practice kind of Urgent Care. So I would say that's kind of- in terms of what the billing kind of looks like, and who owns it and whatnot, and then obviously why you would go kind of in general terms.

Melanie: What services does Urgent Care provide? Can you get some tests or scans? And what's not provided by Urgent Care?

Dr. Marzola: So that's a really good question. I worked at Urgent Care for about a year before I went back into primary care, and that was definitely something a lot of people came in, and obviously kind of limits things.

So as far as Urgent Care, I would say the majority - 99% of them - will offer flu test, strep test, urinalysis just in case you're worried about a UTI. A lot of them will offer some rapid STD testing. I would say about 75% - don't quote me on that - but usually will have like an x-ray machine, so if you are worried about a break, a sprain, pneumonia, they can usually check for things.

But those would kind of be the main things. It's going to be things that can be done right away, get a result right away, not necessarily regular labs, bloodwork, although some of them will offer that.

Melanie: So the emergency room. Parents especially, Dr. Marzola, are never quite sure. A child is vomiting, or they have diarrhea, it's a difficult decision. I mean, and we worry about things like appendicitis and such. So when a parent is feeling that insecurity, not sure where to go, what do you want them to know about symptoms, red flags with their children, things that you say, "Go to the E.R."

Dr. Marzola: Of course. So I would say with kids, the biggest thing to look for- and I would say all of our kids, my nieces and nephews get colds and runny noses all the time, coughing, that kind of thing. But the biggest thing for kids - and it's kind of similar for adults - but really big things are obviously any shortness of breath. If your child is not breathing well, that is 911 or right to the E.R. That is definitely one of those things.

As far as like abdominal issues, I would say in most cases if your child is having the kind of abdominal pain where they're crying, they're rolling around, they've not been able to eat or drink anything for most of the day, they're looking dehydrated where maybe they haven't urinated or peed for the past eight hours, that's a sign of dehydration.

So in those instances especially, I would say E.R. And then other things would be like obviously- I would say if your child hits their head and blacks out, or if they got a concussion at a soccer game or a sports game, that would be E.R. If they're actively bleeding, and it's not just a tiny cut, but it's one of those gashes, especially if it's on the face. Because Urgent Cares vary in how they can repair things, because there's different skill levels, so if you have something on the face that needs to be stitched up, you definitely want to go to an E.R. because those doctors have way more experience stitching, and you don't want to get a bad scar on the face.

Melanie: So as long as you brought up cuts, that was going to be one of my next questions. We're cooking, we're busy, and you cut yourself. How do you know whether it's something that does require stitches? You cut your finger, you try and stop the bleeding, put a Band-Aid on. When is it something that you say, "Okay, I really do need to get in and see somebody"?

Dr. Marzola: I would say- you kind of mentioned it, the bleeding thing. If you cut yourself, and you clean it off with soap and water, and you hold a little bit of pressure on it, and the bleeding just kind of slowly stops over a couple minutes, you probably don't need to go get checked. Because if the bleeding stops, that means most likely the cut isn't so big that you cut some bigger vessels.

So if it stops bleeding after a couple minutes, you're not bleeding through Band-Aids, I would say that is definitely- you're probably good. You just need to keep it clean and dry, covered, all of that good stuff. But if you have a cut that you've cleaned, and you've held pressure on for five or ten minutes, it's still bleeding through every Band-Aid you put it on, and you're having to change your Band-Aid every- even if you're having to change a Band-Aid every thirty minutes if it's seeping through, that's too much. Like you should be going to the E.R. for that. If your Band-Aid is just- you're having to constantly change that thing. Band-Aids are a covering, they shouldn't be soaking in blood, and having to change it every ten to thirty minutes, even every hour would be too much.

And also it depends on the cut size. Like if you have a little cut that looks very superficial, maybe it's like a couple centimeters, and it's like you can tell that it's not deep into the skin, but if you ever have a cut and you start seeing things that doesn't look like skin, like obviously bone, or a little bit of muscle, or you're noticing a little bit of fat tissue, you've cut it pretty deep, so you need to definitely go to the E.R. for those things, but I would say the biggest thing is the bleeding, because you do not want to be bleeding, and bleeding, and bleeding, because that can lead to other problems.

Melanie: Dr. Marzola, we women, we're busy. We're stressed, we're anxious, we're busy, we're taking care of everybody else.

Dr. Marzola: Yes.

Melanie: There are signs, things that we get; chest pain, headaches, arm pain. We get all of these things from anxiety. When do we worry that it's a stroke and a heart attack and call 911 and rush to the E.R? And you know, this is a question that so many women have. When do we call 911 with these kinds of symptoms?

Dr. Marzola: I would say as a general rule, what I tell my patients is if I'm asking, "Oh, do you have problems with chest pain?" And we talk about it some, but if you've had an ache or pain there randomly, and it comes and it goes away in a couple seconds, that is not something that I would worry about.

I would say if you- some of the biggest things would be if activity brought it on. If you were jogging, if you were running around your house trying to get things cleaned up for something, or running after the kids, walking into a store and you start having chest pain, and then you sit down and it starts to go away, then you get back up and start walking, and it comes back - or doing whatever you were doing - that's a sign there's stress on the heart.

So I'd say number one is activity is really bringing that on, that's something you need to get checked out right away. Number two, I would say, kind of like I was saying before, if it's a fleeting pain, you're like, "Oh, I'm kind of sore. It's gone now, it was just there for a second," that usually is not a major issue.

But if you get pain and you're like, "Okay, this is staying, this is staying and it's intensifying and getting worse, and worse, and worse," you need to get checked on in an E.R. And then when it's associated with things like you're having chest pain and then all of a sudden you're feeling you can't catch your breath, if you're feeling it radiating to your jaw, or down your arm. If you're feeling like you might faint or black out, those would definitely be reasons to go to the E.R. And I would say follow your intuition. Like most women are very good at being intuitive about their body, and if you feel like something is wrong, go to the E.R. The thing, it's better safe than sorry. I tell my patients a lot, "I would rather you be paying for an E.R. bill than a funeral bill." And I know that sounds really morbid, but that is what I would rather people be doing.

And a lot of patients I've had will just tell me, "I just knew something wasn't right. I can't pinpoint it, I felt off, I felt weird, but I knew something was wrong, and I went." And a lot of times, those are the patients that intuition was telling them to go, and something was wrong.

Melanie: What an excellent point you just made about intuition, and how women, we do generally know if something is just not right. We don't always pay attention to it, but we do generally know. Wrap it up for us, Dr. Marzola - you are such an excellent guest - with your best advice about knowing where to go, whether it's Urgent Care or the E.R. and really what do you want listeners to take away from this?

Dr. Marzola: So I would just start with in general, emergency room, think emergency. Think car accident, chest pain, passing out, head injury, severe bleeding, dizziness, sudden weakness, numbness, those kinds of things, like severe abdominal pain. That's the stuff you go right to that E.R.

Urgent Care, I want people to think, "I have a cold. I can't get in with my doctor." "I think I have the flu, I don't think I can get in with my doctor." "I really need a TB test for work and I can't get in with my doctor." "I think I sprained or broke my leg, and I need to check it out so that I can know if I can play basketball tomorrow, or if my son can play basketball, or daughter can play basketball tomorrow."

So I really want people to keep in mind, with an Urgent Care, it's something you could come to your PCP for. So whatever you would- if you want to come to your PCP for it, then don't go to the Urgent Care either, you should be going to the E.R. So Urgent Care is urgent things, like things you can't get in with your regular doctor for.

And I think one of the important things about this is we don't want people to delay care. So sometimes I've had people come to the Urgent Care with chest pain, and then so they spent time getting to the Urgent Care, they spent time getting back there to talk to me, and then we've delayed their care by possibly a couple hours.

And a lot of Urgent Cares try and triage that, but sometimes people don't always say what they're there for, et cetera. So we don't want to delay people's care. If you're in the middle of having a heart attack, stroke, if you're bleeding a lot, we don't want you to wait in a waiting room for two hours. We want you to get where you need to be. So I want people to be educated so that they can get the best help as soon as possible.

And I just- as far as Urgent Cares and E.R's, the other thing is I know money is a big thing. So we all have these high deductible plans, even me. So at the Urgent Care, if you go there for something urgent, a lot of them - even if you don't have insurance or great insurance - they have flat rates. Say $120- and I know that sounds a little expensive, but it's a flat rate, and that will include a lot of times a urine test, a flu test, a strep test, so it's kind of all included there versus the E.R.

If you go there because you have a cough or strep throat, you're going to end up with a really big bill for something that could have been much cheaper on your budget at an Urgent Care. I think it all just comes down to knowing where to go so that you get the right help, and also we know practically like things are about money at times. So you go to the right place for the right thing that's best for your health, best for your budget, best for your family.

Melanie: What a great way to segue out, because it's so important that people do know where to go, and you've cleared up so many of these. Thank you so much, Dr. Marzola, for being with us today. 

For further help in identifying symptoms and getting connected to treatment options nearby, BayCare offers a free HealthNav app so getting the right care at the right place is just a few clicks away. Download HealthNav from the app store or Google Play.

You're listening to BayCare HealthChat. For more information, please visit www.BayCare.org. That's www.BayCare.org. This is Melanie Cole, thanks so much for listening.