You wake up feeling like you got hit by a truck. Your muscles ache, you have chills, you barely have enough strength to get up. “Surely I’m dying,” you think to yourself, “time to see the doctor”. You sit for an hour in the waiting room before being brought back. The doctor comes in, asks what’s wrong, tells you you’re fine and to drink more water, then briskly leaves the room before you’ve even had time to disagree and tell him you’re actually dying and need antibiotics or something.
Many patients come to the doctor’s office expecting to receive a treatment, usually in the form of medication. Those who leave without anything but reassurance usually feel a mix of frustration at not getting anything and regret for even going to the physician in the first place. If only there was a way to know when to go to the doctor and when to stay home. Unfortunately, this question is incredibly difficult. First, people have different thresholds for what they consider sick. Some people will go to the emergency room for a paper cut while other people will make an appointment to be seen in 2 weeks for a life threatening illness or injury. Second, basing recommendations off symptoms are tricky. For example, chest pain could be anything from a pulled muscle or acid reflux to a heart attack. Instead, knowing the medical options may help decide if and when to go to the doctor. TL;DR summary at the bottom.
EMERGENCY ROOM
The ER was initially created to handle life threatening emergencies only. Heart attacks, strokes, trauma, severe infections. Since the passage of EMTALA as well as other factors, the ER has ballooned into the Emergency Department (ED) and frequently sees non life threatening diseases. Even with the change in patient demographic, the ED continues to practice at the highest level of alert; meaning, everything must be evaluated as if an emergency. There are two main reasons for this. 1. The physician generally does not know the patient and therefore cannot make any assumptions, even if the chest pain is a panic attack, they have to run all the tests to rule out heart attack. 2. Liability and risk run high. ED physicians tell each other horror stories of seemingly benign presentations and assumed non life threatening processes causing the death or injury of patients right after discharge, and then of course, the ensuing lawsuit. A trip to the ED will very likely result in labs and imaging, which may be extraneous, but err on the side of caution (CYA, or cover your a**, medicine as the medical field lovingly calls it). Furthermore, going to the ED will cost a hefty sum due to the cost of maintaining the facility for emergency situations and having all the emergency staffing needed. Finally, there will be a wait time based on the location. Academic and city EDs tend to have wait times of several hours for those not actively dying.
In summary, the ED will test and scan you more than you might need to make sure nothing is missed, will cost a lot, and may have a long waiting room time. Only go to the Emergency Department only if you really think you are having an emergency (immediately life threatening injury or illness).
PRIMARY CARE
By definition, primary care should be the point of first contact. Primary Care Physicians (PCP) have the benefit of seeing their patients at least once, ideally, before a sick visit. Knowing the patient reduces overly cautious testing, and follow up visits allow for tracking of the illness over time to monitor for acute or chronic changes.
PCPs routinely deal with the full spectrum of patients- those who routinely seek medical attention for minor self limiting issues to those who only come in only when they’re in true medical crisis, and usually at the behest of a family member. The PCP office is also the cheapest option. They are able to treat the vast majority of illness and also know when something is an emergency, requiring a trip from the office to the ED. Most offices will have same day appointment slots open, but those are limited and many people feel frustrated by having to make a future appointment. No one wants an appointment tomorrow when they feel sick today. Luckily, most common illnesses are not emergencies and do not require immediate attention. For any non-emergent illness, the PCP office is the ideal place to go.
STANDALONE CLINICS
i.e. Urgent Care, Patient First, Med Express. Not quite a primary care office, not quite an emergency room. These clinics have blossomed in number recently due to patients who want to be seen immediately without having to pay the lofty ED fees. While they do provide access without the cost, patients don’t realize they are paying a premium for the same day access. These clinics have the functionality of a primary care office with a price fairly higher than what a primary care office would charge. Many people who go there also assume these clinics have emergency room services or at least some capabilities an ED would have. This is not true. For any real emergencies, the physician there will call 911 and the patient will be billed for both the clinic visit fee and the emergency room plus transport fee. Most of the things seen at these standalone clinics can be handled in the primary care office, in fact they are largely staffed by family doctors anyways. The only time these clinic should be considered is if for some reason there is an immediate need to be seen outside of a life threatening emergency. And there will be a premium paid for the urgency.
There is no good way make a blanket statement about when to see the doctor or when to tough it out at home. Knowing the options can help make the right decision if seeing a doctor feels appropriate.
In summary
Emergency Department: expensive, possibility of unnecessary tests and scans, use for emergencies only (if you think you may die in the next few hours)
Primary Care: cheap, handles triage well and knows their patients, use for first contact
Standalone clinics: expensive, capabilities more like primary care office than ED, use only if urgent but not emergent and be ready to pay a premium for the urgent visit
