Knowing the Difference – When to Choose Urgent Care Over the ER

Intro: MemorialCare Health System, excellence in healthcare, presents Weekly Dose of Wellness. Here is your host, Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. I am Deborah Howell and today our guest is Dr. Ian Bare. He's a board-certified family physician who is also an urgent care physician at MemorialCare Medical Group's Urgent Care in San Juan Capistrano. Today we'll talk about the difference between urgent care and the ER and explain when it's best to choose urgent care. Welcome, Dr. Bare.

Ian Bare, MD: Good morning, Deborah. How are you?

Deborah Howell (Host): Good. So many of us certainly appreciate the hard, hard work you guys do.

Ian Bare, MD: Well, thank you. It's our privilege.

Deborah Howell (Host): Can you describe for us the difference between urgent care and the ER?

Ian Bare, MD: Sure. The main difference between urgent care and the emergency room is the level of acuity. You know, when we think of an emergency room, we think of bad motor vehicle accidents, we think of people having heart attacks and strokes, we think of people with blood pouring out of their head. Whereas in the urgent care, it's a little bit lower acuity ideally. Certainly, we are equipped to triage and get the treatment started for just about anything, but ideally, we shouldn't be seeing life-threatening injuries or potentially life-threatening injuries in the urgent care. I would say the urgent care is a little bit more of an outpatient setting as opposed to the emergency room where it's closely linked with the hospital.

Deborah Howell (Host): Okay. And that sort of ties into my next question to you, like when should you go to the ER if you have a finger that's been flayed open by a box knife or when should one go to an urgent care center instead?

Ian Bare, MD: You know, the finger that's been flayed open by a box knife, I'd say that would be fine to be seen in an urgent care. We're set up, we can close lacerations and other minor to moderate injuries and wounds. The biggest criteria with whether you should go to the emergency room, I think, is two things. Number one, is this a life-threatening or limb-threatening or otherwise, do we have permanent disability at stake? Is this something that needs advanced workup with imaging and blood work immediately? And that's a little bit hard to determine sometimes. But another great thing to consider when we're trying to figure out whether the urgent care or the emergency room is the ideal place for an evaluation is a person's relative risk. Meaning, someone who's very young and healthy, no medical problems, that's going to be something that's a little bit easier to evaluate in an urgent care as opposed to someone who's already had three heart attacks and now they're having some chest pain again. You know, most likely we're going to need to do some further evaluation on that with studies and tests and possibly admission.

Deborah Howell (Host): Sure, sure. Boy, that is very, very helpful because even, you know, I even worked for emergency, you know, physicians groups and it's sometimes a very tough call.

Ian Bare, MD: And you know what? Sometimes you don't know until you've been evaluated. You know, we see some people here who are high risk, who have very, very concerning symptoms and we're able to, you know, do our evaluation whether it's, you know, X-rays or an EKG, physical exam and determine, no, this is something that we can take care of as an outpatient. Whereas there's some people who, you know, had seemingly very benign symptoms that turn out to have some concerning features and, you know, in that case we'll facilitate the transfer and, you know, get a formal evaluation started. But you're right, it is very hard to tell sometimes just based on the symptoms.

Deborah Howell (Host): Right. And people, you know, might tend to panic a little bit and it's justifiable.

Ian Bare, MD: Definitely. I think the most important thing whether you come to urgent care or whether you go to the emergency room is, you know, that we're not ignoring symptoms. That you come and be evaluated. You know, worst case scenario if you come to our urgent care and you have something that requires further evaluation, hey, like I said, we'll get that further evaluation facilitated, we'll get you to the right place.

Deborah Howell (Host): Excellent. Now what type of medical staff works at an urgent care center? Like will one always meet with a physician there?

Ian Bare, MD: I would say the majority of time. Most of the providers that we have are board-certified physicians. We do use some advanced health practitioners, physician assistants and nurse practitioners who are very well trained and who are held to the exact same medical standards that the physicians are. We also have licensed nurses, registered nurses, LVNs. We have very highly trained staff in our urgent care.

Deborah Howell (Host): So one could reasonably expect to receive the same high-quality care at an urgent care center that they would at the ER or maybe even at a doctor's office?

Ian Bare, MD: Absolutely. You know, we're all held to the same medical standard. Now, it's true that the emergency room has more tools at their disposal. You know, more imaging studies with CT scans and MRIs, they can get blood work back much quicker than we can. But, truth be told, I mean, you don't always need a CT scan. You don't always need an MRI, you know. So as far as medical standards, absolutely. We'd all better, you know, whether we're in an outpatient office, an urgent care, or an emergency room, we'd better all be performing up to the same standard.

Deborah Howell (Host): That's great to hear, and, you know, very comforting. Now, is urgent care able to address the medical issues of patients of all ages, from babies all the way to seniors?

Ian Bare, MD: Definitely. That's one of the things that we need to make sure, you know, we see not only all spectrum of injuries and illness, but all of the spectrum of the ages of life. So we will always have in our urgent care someone who has received training in pediatrics, whether that be a pediatrician or a family practitioner, as well as someone who's able to take care of our older patients.

Deborah Howell (Host): Okay. Can you tell me a little bit about the mindset of the urgent care physician and the ER physician?

Ian Bare, MD: Well, I can speak to the mindset of the urgent care physician for you. You know, we see our role as kind of serving as a bridge, as a bridge between the inpatient and outpatient settings. What we try to do is provide timely, convenient service, that's extremely high quality for our patients who either have a family or a primary care doctor or who don't. For those who have a primary care provider, what we want to do is make sure that those patients are able to get evaluation and treatment when they need it. You know, if their primary care doctor is their schedule's full or if they're on vacation or if it's after hours, then we want to make sure that we are available to them. And one of the biggest things that we want to do here in the urgent care is get patients back to see their primary care doctor for follow-up to make sure that, you know, if it's not something we can treat in, you know, one visit, you know, if you've got strep throat, okay, you know, we'll treat you and you're going to get better, you know. If you sprain your ankle and it's not broken, okay maybe you don't need follow-up. But there's a lot of things that we see. You know, blood pressure issues, blood sugar issues, when lab abnormalities come up for more chronic musculoskeletal complaints, where follow-up is so important. And we see ourselves as not trying to supplant the role of the primary care provider but rather to be an extra resource and get patients back in to see their primary care doctor for follow-up. Or for patients who don't have anyone, you know, getting them plugged in with someone who can be their doctor.

Deborah Howell (Host): I love that. I love the extra resource. You know, that's a great way to put it. What are the costs between visiting an urgent care center versus the ER?

Ian Bare, MD: You know, it depends on the insurance plan, but it's generally quite a bit more cost-effective to come to an urgent care. Emergency rooms, you know, with all of those extra resources, with the imaging studies and lab and personnel, they do tend to be quite expensive. With an urgent care we are operating in an outpatient setting, which means we're able to keep the costs a lot lower. Something that is unique to MemorialCare is that we don't have an increased copay or increased office charge for our urgent cares. A lot of places will have a higher after-hours copay or an urgent care level office visit. In MemorialCare Health System, our cost to the patient or cost in copay for the urgent care is exactly the same as what it would be for a normal office visit with any of the other outpatient providers.

Deborah Howell (Host): That is awesome to hear, and I do have a final question for you, doctor. What are the hours of MemorialCare Medical Group Urgent Care offices?

Ian Bare, MD: We are open 365 days a year. That means Christmas, New Year's, every single day we're going to have someone in the office in case you need medical evaluation. During weekdays, we're open 9 a.m. to 9 p.m. And then weekends and holidays, we're open 9 a.m. to 5 p.m.

Deborah Howell (Host): Well, you can't get more comforting than that. Thank you so much, Dr. Bare, for being with us today.

Ian Bare, MD: It's my pleasure, thank you, Deborah.

Deborah Howell (Host): It's been very great to have Dr. Bare on the show today, really informative. To listen to the podcast or for more information, please visit memorialcare.org. That's memorialcare.org. I'm Deborah Howell. Thanks for listening and have yourself a wonderful day.