Transcription:
ER, Urgent Care, or Doctor's Office: When to Go Where

Joey Wahler: To receive medical attention, going to a primary care physician, an urgent care facility, or an emergency room, are all options. So we're discussing how to know which one is right for what ails you. Our guest, Dr. Adam Neter, a family medicine physician with Cumberland Healthcare. This is Healthier You. A podcast from Cumberland Healthcare. Thanks for listening. I'm Joey Wahler. Hi, Dr. Neter. Thanks for joining us.

Adam Neter, MD: Hi. Thank you for having me.

Host: Great to have you. So first, before we get into some details here, when seeking treatment, how much confusion do you find patients have about whether a primary care doctor, an urgent care facility, or the ER is the appropriate choice?

Guest: Well, I think that's a big issue for a lot of patients of knowing where to go and when, there's no real good education on that and then there's less good criteria for it. I mean, reading a recent study, by Truvin Health showed that about 71% of emergency room visits made by patients with employer sponsored insurance coverage were for non-emergency causes. so even the New York state recently had 2 million plus claims. Nine out 10 were for potentially preventable reasons, such as infection sore throat, headaches, urinary tract infections, and ear infections.

Host: Wow, that's pretty eye opening in terms of the numbers, wouldn't you say?

Guest: Oh, yeah. I don't think it's like that across the board, but those were some of the more drastic ones. But it's definitely something that we do see commonly in emergency room.

Host: So that being said, what should you go to an emergency room for and what are some examples you can give from your own experience of things that people wrongly think the ER is for?

Guest: Well, mostly things that are, again, I always like to say if a patient is concerned for their life, for something that could result in loss of life or limb, if not treated immediately, that's usually an emergency. So anything with heart related symptoms, heart disease, including chest pain, severe shortness of breath, any kind of warning, signs of a stroke, numbness in the face, arms, legs. Difficulty moving certain parts of your body, severe bleeding or bleeding that you cannot get control with normal measures.

Typically any kind automobile or, a, work related accident are pretty severe. Poisoning, severe bone injuries, major illnesses, head injuries always. And then obviously mental health things such as suicide attempts, so not necessarily things like depression, a more critical kind of aspect of that.

Host: And then you touched on it a moment ago, but give us a couple of the main examples of things that people come to the emergency room for unnecessarily?

Guest: Well, I can tell you a few that I've had in the past. People coming in at 3:00 AM for refills of, their vitamins, people coming in for chronic back pain issues. Yep. . And we're welcome to see those patients. But again, we try to utilize the emergency room because we do get pretty busy sometimes. So, we do disservice to other patients sometimes in the process. And again, people can sit there for a lot longer than they would at a primary care or urgent care's office for these basic things. But again, yeah, people will come in for basic things like paper cuts even.

I know parents bring their children in for sometimes the second they got some symptoms of any kind of infection or flu. And again, we're very happy to see them, but a lot of times these things can, you know, initially be managed outpatient, with their primary care physicians, or an urgent care, for example. Or sometimes even just monitoring, the symptoms. So again, that phrase of saying it's emergency rooms should be reserved mostly for situations that we're concerned for loss of life or severe impairment, if not getting medical attention immediate.

Host: Gotcha. And as you just mentioned, it's amazing to me as well that people would come and risk sitting in the ER maybe for hours to see someone for something that seems so manageable elsewhere. So let me ask you this. ER personnel also are not in a position to give medical advice or referrals by phone. Am I right? You get a lot of those calls as well?

Guest: Correct. that is a problem. I wish we had a better, option for patients with this. But issue is, again, a lot of times it's legal things. I have never seen you face-to-face. I don't know your history. Someone calls me, asks for basic things about even. Again, a headache, Tylenol dosing. I can't officially say anything because it could be something more severe, potentially. I don't know your history, I don't know any of that stuff. So a lot of times we're limited to just say, if this is a life-threatening emergency or you're very concerned for your health, please come in. You know, we're open 24/7.

We hate to have people come in here sometimes, because they'll come in for a chronic issue, chronic respiratory disease nothing really new. But what happens is people sitting here are sick sometimes. So you can't pick up covid, you can pick up the flu. We do everything and keep everything sterile, but again, these things happen and people do pass things on to each other.

Host: That's a great point because what you're making clear there is that if you show up unnecessarily to the ER, not only might you not get treated for what you're seeking, but you may actually make things worse.

Guest: Yeah. Sometimes that can happen. For sure. Yeah.

Host: So aside from wasting the patient's time, as we've discussed, how much extra burden does going to the ER, unnecessarily put on the emergency staff there on the other side?

Guest: Well, here in Cumberland, we're a little bit limited obviously, you know, we are only a critical access hospital, so it definitely puts a strain on when we get 4, 5, 6 patients on top of that. Plus we do also cover our inpatient service, so anybody who's admitted to the hospital, so,use the physician and some of the staff are bouncing between those two areas. So, things are getting kind of hectic in one or the other. Well then, it gets pretty sticky pretty quickly out there.

Host: Sure. So having covered when one should and shouldn't go to the er. Urgent care locations have become so much more prevalent in recent years as kind of a step between the ER and a primary care visit. So what are the things you should typically go for there?

Guest: So for urgent care, again, is for quick kind of effective things for minor injuries or illnesses that need some urgent attention usually are also in the place of, again, if you do not have a primary care physician or you're in after hours times, then definitely urgent care is a place for you. So, minor cuts, burns, wounds, injuries like that. Small infections, cold flu symptoms, sprains, multiple aches and pains. sometimes people come for allergies and severe muscle aches and earaches, GI symptoms, stomach nausea, vomiting, diarrhea, those kind of things as well. Basically anything that needs urgent attention, but is non-life threatening.

Host: You're breaking it down in a very simple way for people to remember if it's life-threatening or needs to be addressed immediately, er, if it's something of an urgent matter that doesn't quite meet. the ER criteria, urgent care. That of course leaves us now primary care physician and really, am I right, there's still no long-term substitute for seeing a primary care doctor regularly? Meaning how often should most patients get checkups on an ongoing basis, and what are the benefits of that?

Guest: For the average healthy person, I think a yearly visit at least is a good idea because need time to get to know your primary care physician and for them to get to know you, your needs, your requirements, and expectations for your health. My biggest thing is prevention is the best medicine we have. So if we can prevent issues from getting worse or happening, that's my goal of my patients. Same thing a lot of times people come in and by the time they get to see us, it's when they're coming with issues. It's better come with me, don't have issues and monitor things because it's kind of like a car running on low oil.

It can run for a few days, few years even sometimes without an issue. But once it crashes on the highway for you, then you got big problems. And then a lot of times you can't fix some of those. And then it's just about managing them so we can prevent those things. That is my goal and that's what primary care, I think, goals is a lot of times doing a lot of annual exams and screenings, immunizations, chronic disease management, prenatal care. Obviously all the things that urgent care does, sprains, muscle aches, allergies, all that things in between too. That's kind of where we're at with that.

Host: And also nuts and bolts. Things like regular blood work, screenings, vaccines, and of course vaccines are more important than ever, right? You can get all of those at a primary care doctor who can also during that time, either become or stay familiar with your history, right?

Guest: Exactly. Yeah. And a lot of times we don't know we have issues until we find something abnormal. Sometimes on blood work or sometimes even just a screening question for family history can pop up a few things that we see, oh, this could be something we need to take a look at in the future or now. So we definitely have found a few actual genetic disorders and some not even cancers in just by that.

Host: Also, in terms of referrals, obviously a primary care doctor, you kind of alluded to it a little bit earlier, Doc, primary care physician, familiar with you, who's seen you on an ongoing basis, knows maybe some things that are a little bit unique perhaps about your history. He's gonna be, she's gonna be more comfortable making a referral to a specialist than someone seeing you right off the street, right?

Guest: Exactly. Yeah. And that's an important thing cuz sometimes someone just seeing you one time hearing a story from you about what's going on once can make a completely different assumption about what might be going on versus someone that's been seeing you for a few years and you come in with this issue. So family practice, the general practitioner, we're the hub, we do referrals to different physicians, but again, we're that central kind of, a hub for you to bring all your care together, coordinate with other your specialists. Sometimes if we need to get you to the ones that you need to go to.

And again, following up with you if you've been to the ER or urgent care. So, and the important thing with that is too, electronic medical records are a problem sometimes for us because some hospitals don't communicate with each other. So it's always great when our patients come into the ER, urgent care or even to our office, bring in their information from a other hospital, from other states. Have a list of their medications they're taking, what they're taking them for. Cuz a lot of times patients say, yeah, I'm taking that green one for something and I don't know what, but you know, the green one, Yeah. It's a little hard sometimes there,

Host: They don't cover that in medical school for you guys, do they?

Guest: No, they don't cover that at all.

Host: Even you're not in a position to necessarily identify, quote unquote, the green one.

Guest: Yeah, we try our best, but.

Host: Yeah. I mean, there's only so much you can do. You gotta have patience, willing to work with you. And I think that's really what we're talking about here, isn't it?

Guest: Exactly. And another thing that's been post covid, I know covid changed a lot of things in, in medicine, so, I definitely think it's helpful for people and medical staff to know just, you know, where to go. so we use our resources appropriately. I mean, ER visits initially dipped down during the high, the pandemic, about 42% because people just didn't want to go in. They were afraid to catch something. Things are going up, but a lot of physicians, nurses, all kinds of medical staff have burnout, and we are experiencing significant short staffed in various cities, most hospitals, I mean, at this point, it's even hard to transfer patients out sometimes because they might have beds available, but not enough, staff to take care of those peoples in those beds.

So that's a big goal for us here too. We make sure we're using our resources appropriately. Covid made a big thing important too, is telehealth services, which are available too. I definitely encourage people if they're concerned about their health in any way, go to the ER, because again, that's their decision at their discretion. But there's also options for telehealth services they can reach for some basic things if you're after hours, if you're not near an urgent care.

Host: Yep. Telehealth definitely yet another option for some of those simpler things indeed. Well, folks, we trust you're now more familiar with when to go where for medical attention. Dr. Adam Neter. Thanks so much again.

Adam Neter, MD: Thank you for having me. Appreciate it.

Joey Wahler: for more information, please visit cumberlandhealthcare.com. Again, that's cumberlandhealthcare.com. If you found this podcast helpful, please share it on your social media and thanks for listening to Healthier You, a podcast from Cumberland Healthcare. Hoping your health is good health. I'm Joey Wahler.