Disclaimer: This podcast is for informational purposes only and is not intended to be used as personalized medical advice.

Joey Wahler (Host): If you need medical attention besides emergency rooms and doctor's offices, there are increasing numbers of urgent care facilities, and now virtual appointments are available. So we're discussing how to know where to seek care.

This is Be Well with Skagit Regional Health. Thanks for joining us. I'm Joey Wahler. Our guest, Dr. Aaron Arnold. He's a family medical physician at Skagit Regional Health. Dr. Arnold, thanks for joining us.

Dr. Aaron Arnold: Hi, wonderful to be here. Thank you for having me.

Joey Wahler (Host): So first, when needing medical attention in a nutshell, doctor, why is it so important that patients seek the right level of care and thus the proper facility?

Dr. Aaron Arnold: That is a great question. The different facilities correlate to levels of care and intensity or need of care based on the severity of the illness. The techniques and tools at different locations compared to urgent care in the hospital system and in the clinics all vary. The right location will have the right tools to fit basically the level of need based on the illness people are having.

Joey Wahler (Host): So we'll get to some of the differences between them in a moment. But first, if you have a medical issue and aren't sure which type of facility is best, what are a few guidelines you can offer based on your symptoms?

Dr. Aaron Arnold: So anybody experiencing any life-threatening symptoms of any signs of organ failure, chest pain being the most common one. Those are usually an urgent care or more likely emergency room issue. Most of the life-threatening issues that people can walk through a door and can be evaluated first in urgent care, and then quickly assessed and then recommend for either follow-up, stay in urgent care or transfer over to the emergency room. If people, as a general rule of thumb, are questioning, "I think I should go to the ER, but I'm not sure," that's usually a good indication that the ER should be the first place to go.

Joey Wahler (Host): So if you're wondering yes or no on the ER, better safe than sorry.

Dr. Aaron Arnold: Absolutely.

Joey Wahler (Host): So besides chest pain that you mentioned, let's start with the emergency room, what are a few basic needs of people that bring them to the ER? And maybe give us one or two that people think necessitate the ER, when in fact it's usually not needed.

Dr. Aaron Arnold: So besides chest pain, severe shortness of breath, dizziness that people are maybe in threat of or danger of passing out, need to be evaluated in the emergency room. And our common findings for stroke, so change in speech, slurring of words, change in smiles, drooping of the face, any weakness, people cannot lift up their arm or lift up their legs. Those are things that need to be evaluated in the emergency room right away because time is of the essence.

Joey Wahler (Host): So are there a few common or somewhat common things that people show up at the ER for where they're sent elsewhere because they were mistaken and that's not the place for it?

Dr. Aaron Arnold: Probably, the clearest example would be a medication refill. If people are out of a medication, and they're not experiencing any severe symptoms or concern for any threat of life or limb, the ER is definitely not the place to go for that. Other kind of more common things that the ER can handle, but isn't necessarily the most appropriate place would be issues of a rash, a non-severe rash. Even if they are kind of full body, if people are not experiencing any other symptoms like elevated blood pressure, headaches, or fever, something like that can be evaluated at an urgent care.

Joey Wahler (Host): So speaking of urgent care, you touched on it a little bit a moment ago, but to get into some more specifics, urgent care is still relatively new compared to traditional or more longstanding medical facilities, right? So I would imagine some people still have never been to one, aren't familiar with exactly what they're for. Maybe give people a better idea of what they can handle and what they really are not meant for.

Dr. Aaron Arnold: Yeah. So the development of urgent care is a relatively new addition to the medical system in the United States. Traditionally, 20, 30 years ago, people would be able to walk into their general practitioner's office and get an appointment the same day or wait to be seen until there was a break or pause in their general practitioner's schedule to be seen for whatever acute issue they had.

With the changes and increase in population and increase in demand for healthcare, we're not only seeing a supply shortage of, physicians, but also nurses and all the other medical care staff that make delivering care possible. The appointments and time availability are so short in supply that we are now having to offload that increased demand with new care facilities to help address acute issues that we can't otherwise see in our clinic.

Joey Wahler (Host): And then, there's the good old doctor's office, sometimes called a primary care physician, family practice, a clinic. So what are those still for?

Dr. Aaron Arnold: Yeah. So just like urgent cares, to help address acute issues that we can't, but normally could see in our office, the doctor's offices, general practitioners' offices are still here to help maintain our general health, do the general yearly checkups and wellness visits, adjust medications, follow chronic illnesses to make sure people are responding to medications and also to deal with the acute issues, such as high blood pressures, headaches, maybe a new fall, potential broken bone.

One of the big differences between primary care and urgent care facilities nowadays is non-severe traumas, so potential broken bones or dislocations, the primary care offices, not everybody has a splinting or cast material in their primary care and urgent care is becoming the quick first go-to for any potential broken bones, again, that aren't severe. So if people have an injury, their arm is moving well enough, they're not having any numbness, tingling, their arm's not getting purple or changing colors or feeling very cold, the urgent care is a good place to go in, get an X-ray, get an initial splint or cast and then follow-up with an orthopedic physician.

Joey Wahler (Host): Now Skagit Regional Health, as we alluded to, also offers virtual health And Dr. Arnold, we realize that the technology's not quite there yet where the doctor's going to reach through the phone or the computer screen and offer you a thermometer. So what are and aren't those sessions for?

Dr. Aaron Arnold: Yeah. That's a good explanation of some of the limitations of our technology and also some things that the patients can do to help bridge that gap from the technology loss. So we don't and likely won't have the technology to reach out to the screen to have that sensation where we can touch or feel like a mass or a broken bone. But there is a lot that can be done over virtual visits. And most of our providers at Skagit Regional Clinics do offer telemedicine and virtual visits through phone or video.

Patients that have initial equipment to check blood pressure, to check their oxygen saturations and pulse rate, and basic thermometers as well are very helpful to give information to their physicians, to help make the appropriate or give appropriate information to help make the right choice for treating whatever illness they're presenting with.

So while we can't reach out through the screen and listen to the heart and lungs, there's still a lot of diagnostic information that can be obtained through video visits and we can diagnose minor colds, urinary tract infections and other things that we don't necessarily need to kind of reach out, touch feel, see in person.

Joey Wahler (Host): And those virtual sessions also allow for the doctor to prescribe medication in certain instances, right?

Dr. Aaron Arnold: Yes, correct. In certain instances, like a urinary tract infection where all the symptoms are kind of leading up, the physician can also order labs to confirm a diagnosis the patient can then get after the virtual visits. They can also prescribe medications to help treat minor infections, minor illnesses and symptomatic management, such as cough, cold and controlling a non-severe fever.

Joey Wahler (Host): Now, would you agree that what we're talking about here really reminds us of the importance of having a primary care physician, because whether you're going to any of these other options, ER, urgent care, remote, if you've still got a regular doctor who may not be available, may not, as you said, have an appointment available at that moment that you need it, regardless of where you turn, it's still always good to have that man or woman that's already familiar with you to get that report and treat something going forward, right?

Dr. Aaron Arnold: Absolutely. Yes, medicine in general is a whole team of people, providers and staff, that make everything possible. And the primary care physician to a large degree serves as the care coordinator across different specialties and across different levels of the healthcare system. And it is never wrong to call your primary care doctor to say, "I'm still a little confused about where to go. Can you please give me some direction?"

And primary care doctors are wonderful men and women that serve as our support staff. And our nursing staff are all very good and have good training and good skills, especially our nurses to help triage and help make decisions to guide where people need to go and what level of care. And they can also get in contact with the physicians to help with that decision-making. And additionally, with primary care, we always want to be kind of looped in if there's anything new going on so we can follow patients to make sure that the illness has resolved, that they have the follow-up visit to ensure that there are enough medications, that the medications are working appropriately and that there are no concerning side effects or new problems that arise from maybe an initial one.

Joey Wahler (Host): Okay. And then finally, to kind of put a bow on the discussion, again concerning primary care doctors, is the standard still after all these years, that for most of us going to the doctor once a year is the best medicine, pun intended, Dr. Arnold, because of the fact that you want to get checked up on whether there may be something wrong, or even just to tell you that you're perfectly fine, God willing, right?

Dr. Aaron Arnold: Absolutely. One of the first things that we're always taught in medical school is that the body and minds are a black box. And it's really hard to kind of see and especially for ourselves. We only get so much information with our body and the face, looking back at us in the mirror. And a lot of times it takes somebody else to say, "Yes, you're doing great," to just have that reassurance. Or "I'm noticing this new. Is this new or have you had these symptoms or any of these changes that might not have occurred on a day-to-day basis or been readily apparent?" And having just at least that one year visit where we can check some routine labs, have that full body detailed examination can help find some of those small things that might go unnoticed to the average person and even to physicians themselves. We're not immune to needing doctors and medicine.

Joey Wahler (Host): Well, folks, we trust you are now more familiar with where to go for medical care with all those different options now available. Dr. Aaron Arnold, thanks again so much.

Dr. Aaron Arnold: Thank you. It was a pleasure.

Joey Wahler (Host): Same here. And for more information, please do visit SkagitRegionalHealth.org. Again, SkagitRegionalHealth.org. Now, if you found this podcast helpful, please share it on your social media. And thanks for listening to be well with Skagit Regional Health. Hoping your health is good health, I'm Joey Wahler.