In emergency medicine, it’s called the golden hour. The first hour from the time of injury or serious illness is the most important in a person’s life. It’s in that hour that a person has the best chance of survival—if they can get to the level of care they need.
But not every medical problem needs to be addressed by the emergency department, and some are inappropriate for that space.
The most common alternative to a full-blown emergency room visit is the urgent care center, but they are not created equal, and the services offered at these facilities can run the gamut.
There’s also your primary care provider, if you have one, but wait times to see them can span days and weeks depending on their availability. That’s just not fast enough for some conditions.
Both the urgent care center and your doctor’s office are never substitutes for emergency care, so which facility is right for which kind of illness?
What Constitutes an Emergency?
When it comes to illnesses and injuries that need immediate high levels of care, think of the emergency department.
Symptoms such as severe chest pain, shortness of breath, and severe abdominal pain all warrant a visit to the emergency department.
Sufferers of heart attacks sometimes describe their pain as an elephant sitting on their chest. Others report feelings of indigestion or heartburn. Chest pain that moves to the arms or back also calls for alarm.
Abdominal pain can signal a heart attack. It can also be a symptom of emergency conditions such as appendicitis, pancreatitis, gallstones, and gallbladder attacks, as well as other emergencies affecting the blood vessels of the stomach area.
Pain in the back could be the result of kidney stones, and if the stone is blocking the flow of fluid from the kidney to the bladder, a person could develop a life-threatening infection or other complications. Sometimes surgery is needed to remove the stone, but suspected kidney stones are certainly worth a trip to the emergency department.
Signs of stroke should also be cause for alarm and a trip to the emergency room. Those suffering from a stroke may at first appear to be intoxicated due to slurred speech and difficulty walking and balancing. But other symptoms such as a pronounced droop on one side of the face, an inability to raise both arms out straight, and blurry vision can all be telltale signals a person is suffering from a stroke.
Beyond the obvious heart attacks and strokes, other conditions such as broken bones, cuts or lacerations that won’t stop bleeding, or any difficulty breathing also need to be seen by an emergency doctor as soon as possible.
People suffering from severe dehydration, or those with abdominal illnesses, will want to skip urgent care and head right to the hospital. Urgent care centers normally won’t give you any fluid through an IV.
Knowing where to go saves time, and in emergency medicine, time is everything. The sooner a person can get the proper level of care, the better their chance of survival. But most primary care clinics and urgent care centers aren’t equipped to take on life-threatening emergencies.
When to Visit an Urgent Care Center
If your illness or injury isn’t going to kill you but you still need to see a doctor, an urgent care center might be your best bet.
Urgent care centers are equipped to help people with common colds and minor flu symptoms. They can also be the right place to have minor orthopedic injuries—such as minor sprains, muscle strains, and scrapes and bruises—evaluated and treated.
Small lacerations can also be attended to in urgent care centers, though those with injuries to the face might be better off going to the emergency department if a plastic surgeon is needed to do the stitches, as surgeons normally do not work in urgent care.
If all these issues sound more suited for a traditional family medicine practice, you’re right. Urgent care centers are really just hybrid centers set up to handle what would have traditionally been seen in family medicine clinics, says Dr. Jeffrey Nordella, an emergency and family medicine physician who has both worked in emergency departments and has owned urgent care centers, in an interview with The Epoch Times.
But as mentioned, these urgent care clinics are not all created equal.
A Big Problem
Inconsistency among services offered seems to be the biggest issue plaguing urgent care.
While some physicians and practitioners working in these clinics have specialized training to handle what they are likely to see, others—explained Nordella—do not. This means that some urgent cares don’t offer services that a patient might expect.
“You got to know your local urgent care, and what they can handle and what they can’t,” he said.
An uncomfortable urgent care practitioner is likely to send a patient to the emergency department if the health concern exceeds their knowledge. For the patient, this means more time wasted and more medical bills.
Nordella recommends that everyone take the time to visit their local urgent care centers and inquire about the level of training the providers have and the services offered. He calls this “patients guiding their own health care.”
In the early days of emergency medicine, emergency departments were typically staffed with doctors-in-training who were studying other specialized fields of medicine, such as family medicine.
As the model of care changed from that of doctors making house calls to that of people flocking to new, large hospitals, the demand for better physicians’ training grew.
Starting in 1970, doctors began to specialize in emergency medicine, choosing to spend their careers in these departments treating “whatever walks through the door,” said Nordella.
Now, the emergency medicine specialty remains one of the most popular residencies for graduating doctors in the United States. In 2022, a total of 2,702 new doctors began training in emergency medicine (pdf). And since 2018, the number of emergency medicine training slots grew by nearly 30 percent, meaning more emergency medicine doctors are headed into the workforce.
But for a long time, urgent care centers were staffed by a hodgepodge of family and emergency medicine doctors, along with mid-level providers such as physician assistants and nurse practitioners.
Now, a few programs in the United States are teaching these providers specifically to work in urgent care centers. These programs are generally for nurse practitioners and physician assistants, not doctors.
However, Nordella has confidence in the ability of his mid-level coworkers and says that patients need not be afraid of seeing these medical professionals, as much of their training is focused on treating complaints appropriate for urgent care.
Primary Care Remains Critical
If the emergency department is there to save your life and limb, and the urgent care can help you through minor illnesses and scrapes, then where does the traditional primary care provider fit into this puzzle?
The key word in primary care is continuity.
In a perfect world, the patient’s primary care physician will remain with the patient their entire life, monitoring chronic conditions and providing small interventions before major problems begin.
The relationship that develops between patient and doctor leads to better care.
These providers are best suited to continuously monitor and treat a person throughout their life. They develop a deep understanding of their patients, and their patients’ medical conditions and social realities.
“Everybody should have primary care; everybody should have continuity of care,” said Nordella.