When to go to primary care, urgent care, or the ER:

A health care consumer’s guide

by Dr. Joel R. Cooper

I am a family doc who currently works in primary care as well as urgent care. I also worked in a number of very busy ERs during my residency training.

There are some important distinctions between primary care and urgent care. There are also important distinctions between urgent care and the ER.

Unfortunately, most people do not understand these differences/distinctions. It leads to inconvenience and frustration for many patients and in some cases wastes important time for a patient in a potentially life-threatening situation.

DO NOT go to urgent care if you think you are having a heart attack or a stroke.

DO NOT go to urgent care if you think you are having a miscarriage.

DO NOT go to urgent care if you are coughing up bright red blood, vomiting blood, or are hemorrhaging at a rapid rate.

DO NOT go to urgent care if you have suffered a significant head injury or blow to the head or neck.

DO NOT go to urgent care if you have intense abdominal pain, or intractable vomiting accompanied by severe abdominal pain.

DO NOT go to urgent care if you are having the worst headache of your life, or pain anywhere in your body that is more than a “10” on a pain scale of “0 to 10,” with 0 being no pain at all and 10 being the worst pain you’ve had in your life.

DO NOT go to urgent care if you can’t stop an acute asthma attack (“status asthmaticus”), can’t catch your breath, or are having severe shortness of breath accompanied by pain in your chest when you breathe.

DO NOT go to urgent care if you are experiencing sudden vision loss or loss of your peripheral (“side”) vision.

DO NOT go to urgent care if you are having a seizure.

DO NOT go to urgent care if you suffered a back injury and have lost control of your bladder or bowels, have lost sensation in your buttocks, and/or can’t walk because your legs suddenly feel “like jelly.”

DO NOT go to urgent care if you are in diabetic ketoacidosis. Believe me, most diabetics know when they are in this potentially fatal state, because they’ve probably been hospitalized for it before — perhaps as a child or teenager. You can easily recognize them in the ER. They are breathing rapidly and deeply, with breath that smells like acetone. They may also have severe abdominal pain and be vomiting repeatedly and uncontrollably.

All of the above conditions — and many more far too numerous to list here — require rapid evaluation in the ER.

Most urgent care clinics don’t have the ability to do continuous cardiac monitoring, CT scans of the head, chest and abdomen, and STAT lab tests which are often required to make a quick diagnosis and render appropriate emergency care.

In addition, don’t go to urgent care for non-urgent conditions that can be handled in primary care.

Urgent care is really very focused primary care, geared more toward the individual medical complaint or condition (e.g., urinary tract infection, minor laceration, red eye, sinus infection, broken finger, toe, leg, or arm, bronchitis, cough, allergic reaction without airway compromise, rash/dermatitis, sore throat, vaginal yeast infection, etc.) All of these conditions can also be managed in primary care by your primary care physician — that is, if you are willing to wait for an appointment.

Primary care clinics — in contrast to urgent care clinics — normally work on a scheduled-appointment basis, whereas urgent care clinics are almost entirely “walk-in.” You don’t need a scheduled appointment at most urgent care clinics. That doesn’t mean that you may not have to wait, however.

It really depends on how busy the urgent care clinic is when you walk in, how many doctors or other providers are working in the clinic on that particular day or night, and how many procedures — such as suturing an open wound — need to be done ahead of you.

The convenience of urgent care appeals to many health care consumers who either don’t have a primary care physician or who don’t want to wait for an appointment with their primary care physician.

Many patients complain that it takes too long to get in to see their doctor and that’s why they’ve come to urgent care. And some patients really have very little choice except urgent care or the ER if they happen to get sick over the weekend, because many primary care practices are closed on Saturdays and Sundays.

But keep in mind that many primary care offices offer same-day appointments and try to accommodate “walk ins” if it’s possible to do so without “bumping” or disrupting already-scheduled patients.

For more complete “holistic” patient-centered care that addresses your mind, body, and spirit and also for high-quality continuity of care, you need a good primary care physician. Board certified family physicians are best qualified for this job, followed by nurse practitioners and physician assistants.

Board certified pediatricians are best qualified if the patient is a neonate, infant, or very young child, especially if the child has complicated medical conditions.

The public needs to realize that what is most convenient from a health care consumer standpoint does not necessarily equal the highest quality or standard of care. On the other hand, many urgent care clinics hire only board certified family physicians, emergency medicine physicians, or internal medicine physicians. When in doubt, seeing a physician — at least for advice if not actual treatment — is most always your safest bet.

If your condition can wait, go to primary care. If you’re not sure if it can wait, call your family physician and ask. Most primary care practices have an after-hours emergency number you can call as well.

If you are seriously ill and/or have a potentially life-threatening emergency, call 911 and get to the ER immediately. Infants, very young children, pregnant women, the elderly, patients with multiple co-morbidities, and the immunocompromised are the ones who often need urgent or emergency care and should not delay seeking treatment.

I believe that primary care, urgent care, and emergency medicine all play an important and vital role in today’s health care delivery system.

But health care consumers should take the time to understand the important distinctions between primary care, urgent care, and emergency medicine BEFORE they get sick, if at all possible.

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Joel R. Cooper D.O., a board certified family physician, works at 21st Century Family Medicine in Glendale, Ariz. He also works at OneHealth/Alliance Urgent Care.