Should I Go to the Emergency Room?
The first thing that you need to remember is that an emergency room is the most expensive and most inefficient place to get healthcare. Costs are very high in an emergency room because they need to be prepared for anything that walks through the door at any time. This is good in the case of a true emergency but raises the costs significantly for all other care.
It is inefficient because everything in an Emergency Room is treated as an emergency and testing will be done right now even if the tests were done recently, resulting in duplication of services. In addition, the doctor treating you does not know you, does not know your history.
Now if it is a true emergency, an emergency room is certainly the place to go. The issue now is what is an emergency, what is urgent, and what should be taken care of by your primary care physician.
An emergency is defined as a serious, unexpected and often dangerous situation requiring immediate action. Chest pain and shortness of breath, potential signs of a heart attack or a blood clot to your lungs are an emergency. Chest pain that has been present for days, chest pain that only occurs in certain positions or chest pain that is caused from chest tenderness is not.
Cough with fever and shortness of breath can be an emergency. Cough without fever or shortness of breath is not, especially if you are under 50 years old and are otherwise healthy.
Passing out is an emergency. Feeling lightheaded is not and you should call your doctor. Stroke symptoms, an inability to use a limb due to total loss of strength, inability to speak, go to an emergency room. Severe abdominal pain, go to an emergency room. For a bellyache call your doctor. A broken bone such as hip, leg, upper arm, go to an emergency room. For a forearm, finger, toe, urgent care may be a better option. Sudden loss of vision, an emergency room, red eye, call your doctor.
Many conditions that are treated in an emergency room can be prevented with attention to chronic conditions. If you have been diagnosed with heart failure, make sure you stay on your diet, avoid sodium and take your medications as prescribed. Often before going to the emergency room, there have been symptoms present for several days. If you would call your doctor early when these symptoms are starting, an emergency room visit can often be prevented. Symptoms such as increased shortness of breath, increased weight or increased swelling in ankles or legs are warning signs that you may be in for an exacerbation of your heart failure. A call to your doctor and a visit today may prevent an emergency room visit and hospitalization tomorrow.
The same goes if you have been diagnosed with COPD, emphysema, chronic bronchitis or asthma. An increase in shortness of breath, wheezing, or new or change in cough or sputum should cause you to see your doctor today to prevent an emergency room visit tomorrow.
Many times, people get sick on holidays or weekends when their doctor’s office is closed. You may not want to wait until the doctor’s office is open. First, remember most doctors have someone taking call, whether themselves or a colleague. One could always call their doctor’s exchange for care. Don’t expect to call and get antibiotics for a cold you have had all week but never called because you know your doctor does not give antibiotics for a cold. (Good for them). The on-call doctor won’t either. But they will treat you appropriately for what you have.
If it is more serious, consider an urgent care center. An urgent care can handle a myriad of problems and will cost significantly less than an emergency room with significantly less waiting time. An emergency room will triage patients based on their severity, so if you go to the emergency room for a cold or sinus symptoms expect to be at the back of the line in terms of waiting.
Back pain is a very common problem with many potential causes. Very few of the causes for back pain require an emergency room visit.
If the pain is from a fall or accident, an emergency room visit may be appropriate. If, along with the back pain, you lose control of your bowel or bladder, an emergency room visit may be appropriate. If you have cancer, fever or loss of use of your legs, an emergency room visit may be appropriate. Otherwise, again, you will be at the end of the line in the emergency room and only receive “band-aid” treatment. Back pain, in general, requires an evaluation inappropriate for an emergency room, and a comprehensive care plan, again something not done in an emergency room.
For abdominal pain, any severe pain should prompt an emergency room visit. Pain in the right upper area could be a gall bladder attack, pain in the right lower section could be appendicitis. Pain in the left lower area could be diverticulitis. Blood in the stool could be diverticulitis, black tarry stools could be a bleeding ulcer. Severe mid abdominal pain that radiates to your back could be pancreatitis. Pain with nausea and vomiting could be a bowel obstruction or an ileus. All of these are appropriate for an emergency room. For other abdominal complaints, please call your doctor for advice.
Headaches are very subjective. There are many causes, most of them benign and/or chronic. If you have a history of headaches, you should not need to go to the emergency room. At most an urgent care should be sufficient, better yet let your doctor handle it. If it is significantly more severe than usual, as in the worst headache of your life severity, go to an emergency room. If there are any neurologic symptoms such as numbness or weakness in one side of your body or difficulty speaking, an emergency room is warranted. Headache with visual disturbances is tricky. If you have had them before, you should not need to be evaluated in an emergency room. If it is a first-time occurrence, an emergency room visit could be recommended.
If you do not typically get headaches and have a new, severe headache, I would recommend an emergency room visit. Most other headaches could reasonably be evaluated by your doctor or at most an urgent care.
Palpitations or heart fluttering is another reason many people go to the emergency room. When you feel your heart is racing, you feel lightheaded, have shortness of breath or chest pain, go to the emergency room. If you are otherwise healthy and you feel your heart fluttering of and on, or only occasionally, call your doctor for advice.
High blood pressure, unless it is in the 220/120 range is not a reason to go to the emergency room. Call your physician about this.
If you fall and severely injure yourself, an emergency room is warranted. If you fall and sprain an ankle, call your doctor.
For uncomplicated urinary tract infections, call your doctor. For urinary symptoms with fever, chills, decreased blood pressure or change in mental status, an emergency room would be recommended.
Poison ivy or other rashes will put you at the very end of the line in an emergency room. Expect hours in the waiting room.
I think I have covered most of the appropriate and many of the inappropriate reasons people go to the emergency room. If there is any question at all, it never hurts to CALL YOUR DOCTOR first.