Jay Itzkowitz, MD, MBA, FACEP
Jay Itzkowitz, MD, MBA, FACEP, Chair of Emergency Services at Mount Sinai Hospital South Nassau in Oceanside, New York. Dr. Itzkowitz is a 2023 Castle Connolly top doctor for emergency medicine.
When you have an unexpected illness or injury, you have a variety of options: your doctor’s office, a walk-in medical clinic, an urgent care center, an emergency room (ER) or calling 911. The choice you make could be the difference between a long and short wait, a big or small bill, and in some cases, life or death.
The ER is a lot more than just a room. It is the center for a hospital service called emergency medicine, which is a medical department and specialty, just like the departments of surgery or internal medicine. If someone is having any type of life-threatening emergency or any condition that can cause significant disability, the emergency department is the place to go. The American Board of Emergency Medicine describes the following conditions as emergencies:
Other reasons to use the ER may include a head injury with loss of consciousness or confusion, a severe burn, a seizure, possible poisoning or overdose, vomiting or diarrhea that won’t stop, heavy bleeding from any cause, high fever with stiff neck, any serious injury that causes loss of movement, or very severe pain.
Doctors who specialize in emergency medicine are trained to make immediate decisions and take actions needed to prevent death or disability.
They head a team of nurses, medical technicians, and other health-care providers who are available 24 hours a day. Emergency medicine doctors are certified by the American Board of Emergency Medicine. Before certification, a doctor must have at least three years of training in emergency medicine.
If you are not sure if your condition is an emergency, your insurance company may have a nurse hotline that can help you decide if you need to go to an emergency department or to an urgent care center. You can also call your primary care provider. If your provider is not available, there should be an on-call doctor to help you decide.
Even though the ER is supposed to be for emergencies, many people use it for less serious medical problems or injuries.
If you are not in a life-threatening
situation, you may have to wait. Generally, concerns like colds, earaches, rashes that aren’t affecting your breathing, and other discomforts that are not life-threatening are better treated in an urgent care facility, retail health clinic, or doctor’s office.
When you arrive at the ER, you may see a waiting room full of patients. Unlike at a doctor’s office, ERs are not first-come, first-served. Instead, people are triaged: A trained health-care provider, usually a nurse, will assess you and decide how quickly you need to be seen and, importantly, how urgent your needs are compared with other people who are waiting.
If there are more serious emergencies in front of you, you may need to wait, and that can mean a long wait at a busy ER—even if you arrive by ambulance. Becker’s Hospital Review reports that the average wait time is as little as 104 minutes in North Dakota and as long as 228 minutes in Maryland. Even if the waiting room looks empty, the treatment area may be filled with patients.
It’s a good idea to bring something to read and your phone (and a charger), so you can keep in contact with your family. Having someone to stay with you and help you through the process is helpful for support and for another set of ears. Having your primary physician call the emergency department to give them a heads-up for what is coming in can be a good idea, as the physician can give the ER providers additional information that you might not be aware of, but it won’t affect your wait time.
If you have a chronic illness, keep an updated file containing any physician reports, test results, allergies, and medications, and take it to the ER. It could save valuable time.
While the wait can be frustrating, know that health-care providers are seeing people as quickly as they can. Yelling at the front-desk staff won’t get you seen any faster. On the other hand, if you’re condition worsens while you’re waiting (for example, you begin to have difficulty breathing) let the triage nurse know so they can ensure that you’re in the right place in line.
After you leave the waiting room, you’ll go to a bed to wait for a doctor. What happens next depends on your condition and diagnosis.
It could include immediate treatment or diagnostic tests. The visit may result in treatment and discharge with instructions for home and follow-up care, admission to the hospital for treatment, or transfer to another facility that may be better suited to treat your condition. After you’re stabilized, you may still have to wait a while to be discharged.
If your problem is not life-threatening or a risk for disability, you can save time and money by going to an urgent care center or even a retail health clinic. Even if you have insurance, your copays for urgent care are likely to be less than for an ER visit or ambulance trip.
Some examples of urgent care problems include common infections, colds, flu, earache, sore throat, nosebleed, nausea, vomiting, diarrhea, stomachache, fevers, rash, sprains, pains, minor burns, cuts, and bruises. In most cases these illnesses and injuries are problems you are familiar with, but you can’t wait for a doctor’s appointment.
Not all urgent cares have the same types of providers. Some may have physician assistants or nurse practitioners. Some urgent care centers have physicians working, but not all the physicians are emergency medicine trained. In any case, most of these centers can manage most nonemergency problems, or get you to the next level of care.
Making the right decision about emergency or urgent care is important. If in doubt about urgent care, call your doctor or health-insurance advice hotline. If you or a loved one are having signs of a heart attack, stroke, or difficulty breathing, go immediately to the ER. If in doubt about a possibly life-threatening situation, call 911. To prepare for these situations make sure you have contact information easily available that includes:
