Scott Webb (Host): I'm sure we've all wondered whether or not a health condition we're experiencing requires going to the emergency department or if urgent care is the right call. And I'm joined today by Dr. David Ramos. He's an Emergency Medicine physician at Salinas Valley Health, and he is here to help us to know where to go when we need medical attention.

 This is Ask the Experts, the podcast from Salinas Valley Health. I'm Scott Webb.

Dr. Ramos, it's nice to have you back on the podcast. Today we're talking about ER versus urgent care, so maybe you could just start by explaining the difference between an ED, an emergency department, and an urgent care clinic, and why it's important for people to know which setting to choose when they do need that care whether, it's overnight or whenever.

David Ramos, MD: Sure the emergency room is staffed with folks that do just like it says emergent care. They distinguish between what is emergent, what is urgent, but the lens that they're looking through is everything's at its worst, and then they gotta peel the not so emergent away. And that's what the emergency rooms do.

They do things like, you know, traumas where there's a lot of bleeding or internal injuries. Emergency rooms will do that chest pain where it's compromising vital signs, in terms of a heart attack or a collapsed lung. They're going to be looking at abdominal pain, in terms of something catastrophic going on in whether a smoldering catastrophe, like an appendicitis or sudden onset pain that might represent something bleeding inside.

 Where the urgent care is more leaning towards that acute issue that came up that you may not be able to get into your doctor's office about overnight. A fever with your youngster that is relieving with Tylenol or Motrin, may look like a cold, but you're not entirely sure and your youngster looks pretty good. A minor cut that, you know, needs stitches, but isn't exposing bone or joint or anything like that. An urgent care can handle that pretty well. If you have a migraine that's happening over and over and over again, and it's happening again, then an urgent care, your doctor's office might be okay, but if it's a sudden onset headache, especially if you have a really high blood pressure, say over 150, over 100, then you may be looking at the emergency room to rule out a bleed inside of your head.

Other sudden things would be, if all of a sudden you find that you're having trouble speaking or understanding people, sudden onset of one sided weakness left or, or right sided weakness. Some of your arms or your legs or even in your face, those are things that you want to bring in.

Host: Yeah. I've heard, there's some common sense involved, of course, but if you suspect you're having a heart attack or a stroke, or you have profuse bleeding, but is that your sense of it, you're just not sure, maybe go the ED, right? Is that your best advice?

David Ramos, MD: Absolutely, because, you know, emergencies are different things to different people. Same way pain is, it's a subjective response, and some folks are just going to have doubts about that. They'll Google something and they'll, they'll look at the worst and then whip themselves up into a frenzy.

And once that happens, I would tell them, just come on over here, we'll sort it out with you.

Host: Leave it in the hands of the experts, right.

David Ramos, MD: Correct. So I'm always going to tell folks when in doubt come to the emergency room, we'll sort it out. And most emergency rooms are like Salinas Valley Health whereby they triage you and they'll send you over to the urgent care side.

We have an urgent care side as well. Um, it may take us a little bit to get to you, but we're able to handle both sides, I think equally well.

Host: Yeah. And I think that's one of the key points, doctor, especially with, getting that free ride, if you will, if you call 911, right? Is that, you know, the treatment begins immediately and could, they call ahead and there could be a stroke team waiting for you, versus us driving ourselves, and that's sort of how I think about, to myself is like, it's not something I really could drive myself for or should be driving myself for, or my wife, a loved one, or whomever, right? If it's one of those things where really we shouldn't be driving anywhere that someone else should be driving us, that's how I have it sorted in my head. What do you think about that?

David Ramos, MD: Yeah, I think so. I mean, I think you're cut off that way is can you drive yourself or can somebody drive you? You know, if somebody's looking at you wondering if they're going to be able to get you there in a timely fashion without you passing out, or worse. And we're talking about chest pain that seems incapacitating or chest pain where it seems like you are about to pass out or a sudden onset headache that seems to be making you unable to function or talk or, or move, shortness of breath where you can't even get out two words to speak a sentence. Those are big deals that way. Mechanism too, you know, we didn't talk about emergency room versus urgent care, but this also branches out into an ambulance. If you've been in a car wreck where both cars are so chewed up that they're totaled, even though you walked out, you might be thinking about certainly coming over to the emergency room and getting checked out.

But that's an ambulance call too. If you're somebody that's helped somebody get out of a car that's totally chewed up, that's a mechanism. If you've fallen, more than, you know, I'm going to say four feet or, some people use the metric system, one and a half meters. Again, I think the big cutoff for ambulance is can you drive yourself or the person's driving, you trusts that you're going to stay conscious long enough that you, no intervention needs to be made. Is that helpful?

Host: Yeah. I think that's so right. And one of the questions I have, doctor, when it comes to urgent care versus our primary, you know, it's sort of like, all right, well this isn't an emergency, right? But it may take me a month or three months to get in to see my doctor, so maybe it's better to just kind of skip that and go right to a Doctor's on duty urgent care, even if it isn't technically urgent.

You follow what I'm saying? You know, like sometimes it just feels like, you know what I, could wait a month to see my doctor, but I don't want to.

David Ramos, MD: There's those kind of problems like getting a refill for your medicines or, you know, a question that you've had with a problem over the course of three months. Acuity is the issue, right? If this is something that's been going on a while and you're perplexed about them, yeah. Certainly you can wait, but you know, in terms of something that sprung up in the middle of the night, your youngster with a fever, maybe with a cold, like I said a cut, from working on something in the kitchen or working on something in the wood shed. Those kind of things. Yeah, they're urgent care and they're urgent care driven.

Host: Right. Yeah. I want to ask you about like older adults, you know, people with chronic health conditions. What's your best advice for them when they're trying to figure out, you know, if this is a part of their condition and should they rush to the ED or can it wait, or should they go to urgent care? What's your best advice for those sort of chronic conditions?

David Ramos, MD: Some of those are, you know, you are moving around in the gray area and those are where the problems arise. And so I always lean towards bringing them to the emergency room. Because the urgent care may not be the primary doctor that's used to looking at them and understanding what an elderly or chronically ill person's baseline looks like.

So, and, I think we were more equipped to, to sort that out. And, again, I'm using incapacity in the face of their chronic illness, like COPDers, you know, they always look short of breath and it's hard to understand, even for the folks that are around you know, their emphysema, to realize, you know, is this really bad or is this grandma's

Host: Just, just another day for grandma, right?

David Ramos, MD: Right, exactly. And I would just say, just bring them on over to us because the urgent cares is going to have the same problem. Right. So, elderly folks, you know, and elderly folks like to hide stuff a lot. What I mean by that is, their symptoms are real subtle a lot of the times, and so just better to get them in there and get the battery of tests and then look things over and make a decision that way. We have a plethora of equipment and things that way that urgent cares don't have.

Host: Yeah, lots of equipment and lots of options. So let's start here just to let folks know in case they don't, where is the Salinas Valley Health ED located?

David Ramos, MD: It is at 450 East Romy Lane back of the hospital. Really better way to put it is on San Jose Street. And so it's right over there, I guess the best way to call it, South Salinas.

Host: South Salinas. Got it. Yeah, and I know there are several doctors on duty, urgent care locations on the central coast located in Salinas, Marina, Seaside, Monterey, Watsonville, Santa Cruz, and Aptos. Just want to give you a chance here at the end, just kind of final thoughts, takeaways, when folks are going through this debate in their head, whenever it is, you know, during the day, after hours, should I go here or should I go there?

What's your best advice?

David Ramos, MD: Like I said, if there's any doubts and you're really worried, come see us in the emergency room. But, don't beat yourself up if you think you made the wrong choice. Urgent care is probably a good start, but if you have doubts that way, if you're incapacitated, you can't drive yourself or somebody can't drive you because you're so incapacitated, look at an ambulance. At the very least, look at getting over to the emergency room.

Host: That's perfect. Well, as always, we got Spanish and English versions out of you, doctor, which, which we really appreciate. So as always, thank you so much for your time.

David Ramos, MD: Sure thing.

Host: And to listen to more of our podcasts, please visit salinasvalleyhealth.com/podcasts. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor, or family member. And subscribe, rate and review this podcast, and check out the entire podcast library for additional topics of interest. This is Ask the Experts from Salinas Valley Health. I'm Scott Webb. Stay well, and we'll talk again next time.