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Choosing the Right Care
If you have an injury or illness, where should you go for treatment? Dr. Christopher Scheid, family medicine physician with College Avenue Family Medicine, Associate Program Director for Family Medicine Residency UPMC Lititz, and Regional Medical Director UPMC Express Care/Occupational Health in the Lancaster Market, discusses where to seek care for various conditions.
Featuring:
Christopher Scheid, DO
Dr. Christopher Scheid is a family medicine physician with both College Avenue Family Medicine and UPMC Express Care Lancaster. He received a Bachelor of Arts in biological foundations of behavior, neuroscience, from Franklin & Marshall College in Lancaster, and a Doctor of Osteopathic Medicine from Philadelphia College of Osteopathic Medicine in Philadelphia. He completed his family medicine residency at UPMC Altoona where he served as chief resident. His approach to medicine is treating the whole person and not just an illness or condition. Transcription:
Bill Klaproth (Host): So, when you have a sudden unexpected illness or injury; where should you go? How do you choose the right care? You’ve got the Emergency Department. You’ve got Express Care. You’ve got your Primary Physician. What do you do? Well let’s find out with Dr. Christopher Scheid, a Family Medicine Physician with both College Avenue Family Medicine and UPMC Express Care Lancaster.
This is Healthier YOU, a podcast from UPMC Pinnacle. I’m Bill Klaproth. Dr. Scheid, when you have a sudden unexpected illness or injury, where should you go?
Christopher Scheid, DO (Guest): I think it would depend on what the injury is and what’s going on. If you have something that is severe, and it’s something that’s worse than anything you’ve ever experienced before; you want to at least start thinking about should I go to the Emergency Department. If it’s something that seems like it’s mild and you can kind of take care of it, kind of control whatever is going on and you think that maybe I could take care of this at home or should I go and at least get it checked out. Then that would be something that I would urge people to go to a convenient care location or an urgent care type location. But basically, most people – I tell people just to kind of use common sense. If it seems like it’s something that’s really severe; it probably is and then you need to look for emergency help.
Host: So, severe and mild. Those are two words to remember. So, are there certain situations where you should always call 9-1-1? Or go to an emergency department?
Dr. Scheid: If you’re having an episode of severe chest pain or severe shortness of breath and you do not have any history of these sorts of things and you’ve never experienced something that severe with the shortness of breath or chest pain; then you definitely want to call EMS, try to get 9-1-1 on the phone so you can get to the emergency department as quickly as possible. Other things you may want to think about too is if you have abdominal pain, or you have something that is so painful that you can’t even talk, you are bent over and you can barely stand up; that would be something where you’re probably going to need to be evaluated in an emergency room, be ruled out for things that might require surgery or quick interventions.
Host: So, those are really good signs and symptoms we should all remember. Chest pain, shortness of breath, abdominal pain, you can’t talk or can’t stand. In those situations, make sure you go to the emergency department. So, I know there are always exceptions, but what are some conditions that can normally be treated in a primary care or Express care setting rather than an emergency department?
Dr. Scheid: Absolutely. Things that are recurrent or things that patients have a history of, there are often things that can be treated in those types of settings. For example, someone that has a history of headaches; if they have a headache that’s similar to their previous headaches, there’s a very high likelihood that it’s something that can be treated in a primary care or an Express care setting. If it’s someone who has mild symptoms like cold symptoms, maybe it’s a urinary tract infection and they have history of having similar symptoms. Maybe it’s a bronchitis and they are coughing a lot, but they are not really having fevers. They are not really having severe body aches or symptoms that are unusual for what they’ve had before; then that would be another situation. And even things like asthma attacks. Someone that has a history of asthma; they know what an asthma attack is like.
Often, if it’s an asthma attack that they have experienced before; they know that they can go in and be seen in an outpatient setting like a primary care or an Express care, get the treatment, get started on medications and they don’t have to go an wait in the emergency room to be seen.
Host: So, for recurrent symptoms or more mild symptoms, symptoms that may occur over a period of time; for that you can go to an Express care setting or your primary care physician. So, then how do you decide between your primary care physician and urgent or express care?
Dr. Scheid: So, I’m trained as a primary care physician and I do both and I always recommend that patients reach out to the primary care and try to see the primary care provider first regardless of what’s going on and usually they can give the folks an idea over the phone if it’s appropriate or if they need to seek care elsewhere. Unfortunately, we often have shortages of primary care and we have limited hours and we have things where people don’t just get sick between eight o’clock and five o’clock during the weekday. So, there are times where the primary care is not available and it’s something that needs to be seen within a few hours and that’s where you start to think about should I go to an urgent care, an express care or something like that. And I think again, the key is having some common sense and thinking about the situation. If it’s something that really seems like it’s severe or emergent and it needs to be taken care of right away; then you need to start thinking where can I get in quickly. If I call my family doctor, and they can give me an appointment in four or five days, that may not be appropriate given what’s going on.
Host: I like how you phrase that, use common sense. So, first try your primary care physician. If they are not available, or the office is closed, you can’t get in; then try express care. So, might there be people asking themselves why can’t I just use express care as my primary care? What’s the benefit of having a dedicated PCP?
Dr. Scheid: Yeah, I get that question all the time. Because I do both. And what’s really challenging for me is when the patients come in and they are used to seeing me in both settings and they are like why can’t just see you here at ten o’clock on a Saturday instead of making an appointment in the office to come see you? And I think the key to primary care is that primary care has access to your medical records, but they also do get to know you. They sort of know your behaviors; they know how you are when you are healthy. So, when you come in and something is going on; it’s much easier for a primary care provider to realize that something is urgently wrong, or something is going on that’s out of the ordinary because they are used to seeing you when you are healthy and sick.
Unfortunately, when I work in the Express care or the emergency room or the urgent care type settings; I will see people who I’ve never seen before and I don’t know what they’re like on a normal day. I don’t know if this is the most severe thing they’ve ever had or if this is just the way that they always are. So, it’s really important to have that continuity of care. That way people can know you and know how you are when you are healthy so that when things are wrong; they are able to intervene more quickly and do the appropriate workup.
The other thing as well is nowadays with the way our insurance system works; a lot of times if there’s something that requires a specialist or there’s something that requires the patient to go to another facility after they’ve seen the initial provider; then the referral process may be limited if it’s not coming from a primary care. I have issues all the time at the express care and urgent care where I desperately need to send someone to a specialist but because I’m not their primary care; the insurance refuses to allow me to do that.
Host: So, last question Dr. Scheid and thank you for your time. Are there situations where someone will go to Express care but then be sent to an emergency department?
Dr. Scheid: Yes. There are. A lot of people, they do the right thing. They think that oh this is not something that’s overly severe and I don’t want to go to the emergency room and use inappropriate resources so, I’m going to go somewhere else. And then unfortunately, when they get to us and we do vital signs and we examine them; sometimes we find concerning symptoms on physical exam that suggests there could be a surgical emergency and we therefore have to send people to the emergency department to get admitted and be worked up by the surgeons. Additionally, sometimes people come in because they think they have a routine infection but based off of their vital signs, based off of our exam; we’re suspicious that they actually have what’s called sepsis which means that the infection has gotten into their bloodstream. And that’s a situation where you need to be in the hospital probably for several days to be on IV antibiotics and to get the infection cleared up.
I’ve also had instances at our Express care locations where patients come in with some vague symptoms particularly females can present with some vague symptoms and they are actually having a heart attack. And you have to do emergency treatment, call the ambulance, get them to the hospital right away. So, there definitely are times where when you actually get to a an outpatient facility like an Express care or an urgent care; that we will find things that require emergent intervention that we are not able to handle. But again, that’s where having the realization as a patient that you need to get there, need to get seen is appropriate and that’s the whole reason why we have these locations that are open extended hours and weekends so that people can try to do the right thing, try to seek care in the appropriate setting and every now and then, unfortunately, there are times where we have to send them to the hospital.
Host: Well this has been really informative Dr. Scheid. I’ve often wondered myself when is it time to go to primary care or urgent care or the emergency department. So, thanks for clearing this up for us. We appreciate your time.
Dr. Scheid: Thank you very much. I appreciate it.
Host: That’s Dr. Christopher Scheid and for more information about choosing the right care please visit www.upmcpinnacle.com/rightcare. That’s www.upmcpinnacle.com/rightcare. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Healthier YOU, a podcast from UPMC Pinnacle. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): So, when you have a sudden unexpected illness or injury; where should you go? How do you choose the right care? You’ve got the Emergency Department. You’ve got Express Care. You’ve got your Primary Physician. What do you do? Well let’s find out with Dr. Christopher Scheid, a Family Medicine Physician with both College Avenue Family Medicine and UPMC Express Care Lancaster.
This is Healthier YOU, a podcast from UPMC Pinnacle. I’m Bill Klaproth. Dr. Scheid, when you have a sudden unexpected illness or injury, where should you go?
Christopher Scheid, DO (Guest): I think it would depend on what the injury is and what’s going on. If you have something that is severe, and it’s something that’s worse than anything you’ve ever experienced before; you want to at least start thinking about should I go to the Emergency Department. If it’s something that seems like it’s mild and you can kind of take care of it, kind of control whatever is going on and you think that maybe I could take care of this at home or should I go and at least get it checked out. Then that would be something that I would urge people to go to a convenient care location or an urgent care type location. But basically, most people – I tell people just to kind of use common sense. If it seems like it’s something that’s really severe; it probably is and then you need to look for emergency help.
Host: So, severe and mild. Those are two words to remember. So, are there certain situations where you should always call 9-1-1? Or go to an emergency department?
Dr. Scheid: If you’re having an episode of severe chest pain or severe shortness of breath and you do not have any history of these sorts of things and you’ve never experienced something that severe with the shortness of breath or chest pain; then you definitely want to call EMS, try to get 9-1-1 on the phone so you can get to the emergency department as quickly as possible. Other things you may want to think about too is if you have abdominal pain, or you have something that is so painful that you can’t even talk, you are bent over and you can barely stand up; that would be something where you’re probably going to need to be evaluated in an emergency room, be ruled out for things that might require surgery or quick interventions.
Host: So, those are really good signs and symptoms we should all remember. Chest pain, shortness of breath, abdominal pain, you can’t talk or can’t stand. In those situations, make sure you go to the emergency department. So, I know there are always exceptions, but what are some conditions that can normally be treated in a primary care or Express care setting rather than an emergency department?
Dr. Scheid: Absolutely. Things that are recurrent or things that patients have a history of, there are often things that can be treated in those types of settings. For example, someone that has a history of headaches; if they have a headache that’s similar to their previous headaches, there’s a very high likelihood that it’s something that can be treated in a primary care or an Express care setting. If it’s someone who has mild symptoms like cold symptoms, maybe it’s a urinary tract infection and they have history of having similar symptoms. Maybe it’s a bronchitis and they are coughing a lot, but they are not really having fevers. They are not really having severe body aches or symptoms that are unusual for what they’ve had before; then that would be another situation. And even things like asthma attacks. Someone that has a history of asthma; they know what an asthma attack is like.
Often, if it’s an asthma attack that they have experienced before; they know that they can go in and be seen in an outpatient setting like a primary care or an Express care, get the treatment, get started on medications and they don’t have to go an wait in the emergency room to be seen.
Host: So, for recurrent symptoms or more mild symptoms, symptoms that may occur over a period of time; for that you can go to an Express care setting or your primary care physician. So, then how do you decide between your primary care physician and urgent or express care?
Dr. Scheid: So, I’m trained as a primary care physician and I do both and I always recommend that patients reach out to the primary care and try to see the primary care provider first regardless of what’s going on and usually they can give the folks an idea over the phone if it’s appropriate or if they need to seek care elsewhere. Unfortunately, we often have shortages of primary care and we have limited hours and we have things where people don’t just get sick between eight o’clock and five o’clock during the weekday. So, there are times where the primary care is not available and it’s something that needs to be seen within a few hours and that’s where you start to think about should I go to an urgent care, an express care or something like that. And I think again, the key is having some common sense and thinking about the situation. If it’s something that really seems like it’s severe or emergent and it needs to be taken care of right away; then you need to start thinking where can I get in quickly. If I call my family doctor, and they can give me an appointment in four or five days, that may not be appropriate given what’s going on.
Host: I like how you phrase that, use common sense. So, first try your primary care physician. If they are not available, or the office is closed, you can’t get in; then try express care. So, might there be people asking themselves why can’t I just use express care as my primary care? What’s the benefit of having a dedicated PCP?
Dr. Scheid: Yeah, I get that question all the time. Because I do both. And what’s really challenging for me is when the patients come in and they are used to seeing me in both settings and they are like why can’t just see you here at ten o’clock on a Saturday instead of making an appointment in the office to come see you? And I think the key to primary care is that primary care has access to your medical records, but they also do get to know you. They sort of know your behaviors; they know how you are when you are healthy. So, when you come in and something is going on; it’s much easier for a primary care provider to realize that something is urgently wrong, or something is going on that’s out of the ordinary because they are used to seeing you when you are healthy and sick.
Unfortunately, when I work in the Express care or the emergency room or the urgent care type settings; I will see people who I’ve never seen before and I don’t know what they’re like on a normal day. I don’t know if this is the most severe thing they’ve ever had or if this is just the way that they always are. So, it’s really important to have that continuity of care. That way people can know you and know how you are when you are healthy so that when things are wrong; they are able to intervene more quickly and do the appropriate workup.
The other thing as well is nowadays with the way our insurance system works; a lot of times if there’s something that requires a specialist or there’s something that requires the patient to go to another facility after they’ve seen the initial provider; then the referral process may be limited if it’s not coming from a primary care. I have issues all the time at the express care and urgent care where I desperately need to send someone to a specialist but because I’m not their primary care; the insurance refuses to allow me to do that.
Host: So, last question Dr. Scheid and thank you for your time. Are there situations where someone will go to Express care but then be sent to an emergency department?
Dr. Scheid: Yes. There are. A lot of people, they do the right thing. They think that oh this is not something that’s overly severe and I don’t want to go to the emergency room and use inappropriate resources so, I’m going to go somewhere else. And then unfortunately, when they get to us and we do vital signs and we examine them; sometimes we find concerning symptoms on physical exam that suggests there could be a surgical emergency and we therefore have to send people to the emergency department to get admitted and be worked up by the surgeons. Additionally, sometimes people come in because they think they have a routine infection but based off of their vital signs, based off of our exam; we’re suspicious that they actually have what’s called sepsis which means that the infection has gotten into their bloodstream. And that’s a situation where you need to be in the hospital probably for several days to be on IV antibiotics and to get the infection cleared up.
I’ve also had instances at our Express care locations where patients come in with some vague symptoms particularly females can present with some vague symptoms and they are actually having a heart attack. And you have to do emergency treatment, call the ambulance, get them to the hospital right away. So, there definitely are times where when you actually get to a an outpatient facility like an Express care or an urgent care; that we will find things that require emergent intervention that we are not able to handle. But again, that’s where having the realization as a patient that you need to get there, need to get seen is appropriate and that’s the whole reason why we have these locations that are open extended hours and weekends so that people can try to do the right thing, try to seek care in the appropriate setting and every now and then, unfortunately, there are times where we have to send them to the hospital.
Host: Well this has been really informative Dr. Scheid. I’ve often wondered myself when is it time to go to primary care or urgent care or the emergency department. So, thanks for clearing this up for us. We appreciate your time.
Dr. Scheid: Thank you very much. I appreciate it.
Host: That’s Dr. Christopher Scheid and for more information about choosing the right care please visit www.upmcpinnacle.com/rightcare. That’s www.upmcpinnacle.com/rightcare. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Healthier YOU, a podcast from UPMC Pinnacle. I’m Bill Klaproth. Thanks for listening.