Joey Wahler (Host): It's an important distinction to make. And so, we're discussing immediate care versus emergency care. Our guests are Dr. Daniel Miller, Vice President and Chief Quality Officer, as well as Medical Director for Immediate Care Centers; and Dr. Caleb Powell, he is Vice Chief, Emergency Medicine, Brunswick and Camden campuses.

This is Health Matters from Southeast Georgia Health System. Thanks so much for joining us. I'm Joey Wahler. Hi there, Doctors. Welcome.

Caleb F. Powell, DO: Hey.

Daniel L. Miller, MD: Hello.

Host: I don't think anyone needs to have attended medical school to realize that my voice is a bit hoarse. Forgive me for that. But fortunately, the two doctors sound perfectly fine. First, Dr. Miller, what drew you to healthcare in the first place and your particular specialty for that matter? Why this?

Daniel L. Miller, MD: I come from a family of doctors, my grandfather, my father, my brother, my sister. They told me it wasn't the family business, but I'm a political science major from college. I thought I was going to go into law, but everything sort of led to medical school. And so, I trained at the Medical College of Georgia.

Chose emergency medicine because I really liked the variety. You come in in the morning and you just don't know what you're going to see that day. There's a lot of excitement. and I trained in Jacksonville, Florida. I'm board-certified and residency-trained in emergency medicine. But my father had started Glynn Immediate Care in Brunswick about 45 years ago, and it was one of the first freestanding urgent care clinics in Georgia. And he wanted me to come home and work with him, and the hours were a little more regular, not as many weekends, and so it was really good. I'd just started a family, several children. And it was the perfect career for me.

Host: Boy. And so, when you're having a family get-together and someone says, "Is there a doctor in the house?" You ain't kidding, right?

Daniel L. Miller, MD: Well, it gets worse. My wife is a doctor. I have two kids in medical school and two more planning to go. I'm not sure how it all happened.

Host: So, no one owns a deli, for instance.

Daniel L. Miller, MD: No, no. I was hoping for one like engineer, architect, something. But no luck.

Host: Gotcha. Gotcha. Wow, that's really interesting. And so, in a nutshell, Doctor, what does your position entail?

Daniel L. Miller, MD: So for the urgent care, I direct the two urgent cares. One is Glynn Immediate Care and the other one's at Glynco, which is out by 95. We see anywhere from, you know, between the two clinics, 80 to 130 patients a day. And so, they're very busy with minor emergencies. I supervise several nurse practitioners, review their charts, do the education.

And then, starting in January, the hospital asked me if I'd like to come on as the chief quality officer. And so, now I'm 50% clinical and 50% administrative, and it allows me to affect patient lives and their quality of their care on a sort of a global or macro level rather than the micro level. So, I get a little bit of both worlds, and it's really exciting.

Host: Sounds great. And so, Dr. Powell, I'm going to go out on a limb here and guess you don't have quite as many doctors in your family as Dr. Miller does.

Caleb F. Powell, DO: I don't. I am the one doctor in my family. The rest of my family, they're teachers, and my brother works in construction. So yeah, the one and only.

Host: Okay. So, complete contrast there. Why healthcare in your specific area of expertise, would you say?

Caleb F. Powell, DO: So, I kind of fell into it. You know, when I was in college, I worked. I was planning on going into education as well, and then ultimately happened into a job working at a hospital, you know, in Valdosta. And one thing led to another, transferred departments, ended up working in the emergency department and loved it, and then decided to go to medical school.

My wife, you know, she's in healthcare as well, works as a nurse practitioner, and we've kind of traveled through this. But ultimately, you know, after trying quite a few specialties when I was in medical school, settled back on what I felt was home and still is home today, which is the emergency department. So, trained up in Virginia and then did my residency also at UF in Jacksonville, which is a good place. And I ultimately came here with, you know, wife and two kids and very invested in the community.

You know, and probably almost three years ago, myself and Dr. Craig London are the two directors for both campuses in Brunswick and Camden. He serves as chair, and I'm vice chair as far as inside the hospital. But, you know, our role from that perspective is we do a lot of administrative duties from organizing schedule coverage, making sure patient throughput is adequate, so wait times aren't too bad. We work clinical shifts ourselves, you know, just as the other doctors in the group oversee care of patients both with APCs at both campuses, and then also even communicate, you know, on the administrative level throughout the rest of the hospital to try and make things better.

To what Dr. Miller was saying and to echo that, it's you affect change at a different level rather than just direct patient care. But helping some of, you know, moving the progress, especially for this community and this hospital towards a better healthcare avenue for the patients in this area.

Host: All right. And so, Dr. Miller, what would you say is the most common mistake that patients make when deciding between the immediate care center or ICC and the emergency care center or ECC? What's the biggest mistake?

Daniel L. Miller, MD: The biggest mistake that people make is thinking that we provide equivalent services. We can do a lot at the immediate care, but we do not have the resources that the emergency department has. We can do X-ray, we can do some lab work, we can take care of minor injuries, we can take care of minor illnesses. But what we can't do is treat the high acuity, severe illnesses that the emergency department can.

And the fact that we are separate from the hospital, if you are having a medical emergency and you present to to the Immediate care center, you're really delaying the care that you really need, that you would be able to get immediately if you had gone to the emergency department.

Host: Yeah, that's a great point. And so Dr. Powell, what types of conditions or red flag symptoms would typically send someone straight to the ECC versus ICC?

Caleb F. Powell, DO: So, things such as chest pain, shortness of breath, sudden onset neurologic conditions such as, you know, stroke-like symptoms, slurred speech, inability to move an extremity, seizure, loss of consciousness, deformities, you know, from trauma, any type of bad injuries. And a lot of times, most MVCs, if you're coming by ambulance, you're not going to an immediate care, you're coming to us.

We have pretty much all the resources at our fingertips and can get things done really quickly in a timely fashion so that you can get the care that you need. People that end up coming for even urgent care needs, it's a triage system, soyou'll still notice that we take care of the sickest as soon as we possibly can, and then everybody else from there.

Host: So, Dr. Miller, what are ICCs best suited for, would you say?

Daniel L. Miller, MD: Minor injuries, sprains, strains, backaches, lifting injuries. We see a lot of work-related accidents as well. Minor injuries from a car crash. If you, you know, ran into somebody at 75 miles per hour, you really don't want to be coming to the immediate care. You wanna be going to the emergency department.

And then, really a wide spectrum, adults and children in terms of illness, cold, flu, minor, stomach ailments. We have the capability to evaluate pretty much any minor illness or injury.

Host: And so, that being said, Dr. Powell, what would you say more than anything else the ECC offers that the ICC does not?

Caleb F. Powell, DO: So as far as labs, medications, fluids, things that you can get immediately, as opposed to having to order a test that you would have to go over to another facility or something like that to have done on an outpatient basis. Everything is right here, right now, and you get quick turnaround as far as having those done.

We have the staff, we have the resources also with consultants as far as should you need some life-saving, limb-saving procedure that needs to be done, you're in the place that's set up for that. And should there be something that our facility cannot take care of, we have the means to transport you in an emergent timeframe so that you can get the care that you need in a timely fashion.

Host: And so, Dr. Miller, how should parents typically decide, say, where to go for a sick child? Or then, again, how should patients in general choose between minor injuries like a sprained ankle, which was mentioned, versus more serious issues? What's the sort of rule of thumb would you say?

Daniel L. Miller, MD: I'd say use common sense. If it's something that you would go see your primary care physician for, but you feel like it needs to be seen faster, if you can't get in with your primary care physician, then we're likely to be able to take care of it in the immediate care. In addition, you can call one of our immediate cares and ask a question. If you're unsure as to whether it's something we can take care of, you can call. And depending on how busy we are, we may not answer right away. But if you leave a message, we make sure to get back to everybody who calls.

Host: That's great to hear. Dr. Powell, how can someone weigh other factors when deciding which direction to go in here in terms of weighing costs, convenience, urgency? How do you weigh those factors without risking your health when deciding if it's ICC or ECC?

Caleb F. Powell, DO: I think a lot of it comes down to kind of what Dr. Miller has said as far as common sense to an extent. If you're in a such extremist to where you're thinking life, limb, those types of things, it's a no-brainer when it comes to that. Coming to see us at the ECC is going to be the utmost importance.

And there's, you know, as far as financial cost and things like that, especially with emergent care, there's things that the hospital offers and avenues for dealing with that. Our goal is to take care of people quickly and efficiently and try to rule out any life-threatening condition, or if there is one, that we're there to treat it and we'll handle the nuances of those types of things on the back end.

Host: And Dr. Powell, you kind of answered this next question. But when should someone skip both ICC and ECC altogether and just simply call 911? You mentioned life and limb. That's a good thing to keep in mind in making that call, right?

Caleb F. Powell, DO: Right. Not just injuries or ailments. But like I said, we talked about some of the red flags as far as we touch every specialty, both at immediate care and then also in the ECC. It's going to be the worst possible scenario in every specialty that you could think of. But things such as chest pain, shortness of breath, sudden onset of any type of neurologic disability, or ailment, seizures, coma, unresponsiveness, I mean, those types of things. Those are even things that you need to get there more expediently. So, you know, if transportation's an issue or even if it's not the quickest way to get from where you are to us is using our ambulatory services, such as with 911.

Host: All right. How about, Dr. Miller, one insider tip, if you will, or a misconception that you've experienced that you think most people don't know when it comes to ICC versus ECC but should? What's the main thing people just unfortunately don't get?

Daniel L. Miller, MD: So as far as an insider tip goes, the most important tip I would give is that you can actually make an appointment to come and see us in the immediate care center during the week. You can go online to the Southeast Georgia Health System website, and you can schedule an appointment for the same day.

We have a wait at home or wait in the car option. You can call, register by phone and get notified of when we are ready to see you. So, that'd be my insider tip. I don't know about a misconception, but what I would say is that some people feel like they are— for lack of a better word, like, you know, they apologize like, "Oh, you know, I'm sorry I wasted your time."

And what I would like to tell everybody is there's no such thing as a waste of time. If you're concerned about something, we're here to help. I tell patients all the time, "I'm in the reassurance business." So, I'm there to reassure you you're going to be okay. Or if you've got something significant going on, I'm there to reassure you that we're going to get you into the right people to take care of you and help you through your illness.

Host: Great point. Certainly something people need to be aware of. So now, we're going to switch gears a little bit, and we're going to do a little quick Q&A here where I'm going to throw out some conditions and then have one of you or the other chime in on whether it's your department that would handle it as opposed to the other.

All right. So, let's start with a cut that won't stop bleeding after 10 minutes of pressure. Where do you go?

Daniel L. Miller, MD: There's a caveat to that. We can take care of pretty much all lacerations in the immediate care, and there's a lot of different reasons one would continue to bleed. If, however, you have a cut and there is blood pulsing out, that is something that you need to go to the emergency department for.

A surgery colleague of mine years ago, said something I'd never forget. He said the only bleeding he worries about is bleeding that he can hear. So if you can hear you're bleeding , you need to go to the emergency room.

Host: Good caveat to mention right there. How about a sprained ankle during a pickup basketball game?

Daniel L. Miller, MD: It's definitely immediate care.

Host: All right. Chest pain or trouble breathing

Caleb F. Powell, DO: Definitely emergency care center.

Host: Absolutely. Dehydration from the flu and can't keep fluids down.

Daniel L. Miller, MD: That is an either/or situation. If you're concerned that you might be dehydrated, you need to be assessed either at immediate care or the emergency department. If you're truly dehydrated, we may have to send you over to the emergency department. But most people who are, you know, "dehydrated," really just need antiemetics to stop the vomiting, and then they're able to rehydrate themselves just by drinking Gatorade or water.

Host: All right. A bad fall with wrist swelling and deformity.

Caleb F. Powell, DO: The ECC.

Host: Okay. How about a high fever in a toddler awake at night? A somewhat common occurrence for kids that age.

Caleb F. Powell, DO: So, that would also be ECC and solely based on timing. Emergency department is open 24/7, 365, and it's, you know, all hours of the day. So, you know, something such as that late at night, a lot of times the initial referral, you know, especially from the patient's pediatrician is going to be to, you know, take antipyretics and follow up in the morning.

However, if that's not viable or not, then the ECC would be the next best thing. If it were during daylight hours, then, you know, a child with a fever and can't get in to see their pediatrician could be seen at immediate care as well.

Host: Absolutely. Okay, couple more. How about an ear pain or possible ear infection.

Daniel L. Miller, MD: That is an immediate care complaint.

Host: Okay. And then, we have severe allergic reaction with throat swelling.

Caleb F. Powell, DO: And that would be emergency care center.

Host: Okay. So, that was interesting. I'm sure that cleared up some misconceptions for people that are joining us right now. A couple of other things before we let you go. Dr. Miller, for all those scenarios and in general, child versus adult, does that change anything about where to go?

Daniel L. Miller, MD: We take care of all ages at the immediate care. The only exception to that is for babies under three months old who have a fever, that should be seen in the emergency department.

Host: How about one best tip for choosing which type of care? You've both done such a great job covering the specifics. What's the one general rule of thumb, Dr. Miller, to keep in mind here?

Daniel L. Miller, MD: If you're unsure and you're concerned about something, pick one or the other. And if you come to the immediate care and it's not something we're able to take care of, we'll make sure you get to the place where you can get taken care of.

Host: And how about you, Dr. Powell? I guess Dr. Miller makes the most important point of all, which is if you happen to stumble into the wrong place, even after hearing this conversation, you're going to get the care you need one way or the other, right?

Caleb F. Powell, DO: That's right. So even if you show up in our front door and you have something that could have been taken care of in an immediate care, you will still be screened, you still will be seen. But as I said before, there's definitely a triage process. So if it's not a life-endangering or limb-endangering type of condition, there is a strong chance that it will just delay your care shortly, but not do any detriment to your wellbeing.

Host: Understood. Well, folks, we trust you are now more familiar with immediate care versus emergency care. Doctors, valuable information indeed. Thanks so much again.

Daniel L. Miller, MD: Thank you.

Caleb F. Powell, DO: Thank you.

Host: Absolutely. And for more information, please visit sghs.org/emergency. If you found this podcast helpful, please do share it on your social media. And thanks so much again for being part of Health Matters from Southeast Georgia Health System.