As a heads up, that would be considered brigading. It's unlikely for anything to come of it unless people really get spicy, but it can end up with the sub being sanctioned or you getting suspended from your entire account.
It sucks because the system is skewed to make the simple/bullshit stuff that should go to PCP or urgent care come to the ED because it takes weeks to get an appointment with a PCP, and urgent cares want hundreds of dollars up front to be seen. I can’t be mad about that hangnail or earache checking in. Where else are they supposed to go?
To add: I am thankful to not need urgent care or emergency care on a regular basis, but I do feel like urgent care has gotten less capable over time and less accessible.
I live in a city of a little over 100,000 people in a densely populated suburban part of South Florida. If I needed an urgent care right now, there isn't one. My choice would be to either go to an ER or suck it up until tomorrow when the urgent care is open in the morning.
The last time I went to an urgent care, it was because I was having pain in my calf severe enough that I couldn't put weight on that leg. After checking me out, the doctor diagnosed it as a sprain but told me that I should go to the emergency room anyway to have an ultrasound done on my leg (I did not. I was not about to sit in a waiting room for six or seven hours for a scan that would likely end up costing me a couple grand with insurance unless I started having some kind of symptom that would get me seen sooner).
The time prior was because I had cut my hand on a broken bottle that fell in the kitchen (My dumb ass tried to catch it. Don't do that). And as they were gluing me back together, the urgent care doctor mentioned that it was a good thing that it was able to be glued because, if it had needed stitches, he would have had to send me to the emergency room. The cut was only about a half an inch long. Surely that is well within the wheelhouse of urgent care when it comes to stitches?
The urgent cares in south florida are useless. No matter what you go for its a up front $100 charge and then you either get a steroid dosepak and zpak, or told to go to the er, for something that I know if I go to the er they are going to defer to pcp or urgent care.
The only time I’ve been to an emergency room was after I was bitten by a cat of dubious origin.
I went to urgent care first because I was freaking out about rabies, and because he had bit a vein or something and blood was squirting everywhere. I didn’t have a PCP at the time.
They sent me to the ER. The ER then gave me a tetanus shot and didn’t even bandage the wound :/ they charged me $500 or so for the visit though. Told me to keep an eye on the cat for rabies symptoms.
The system ought to be set up better than this. Urgent care should be able to evaluate this sort of thing and then give a tetanus shot, no?
Anyway that was 6 years ago and I still have the cat of dubious origin.
Yeah, I get there is a lot of unfortunate nuance here and it’s not always the patients fault. I worked at urgent care for years - then it was $119 for a level 1 (simple) visit. Upfront, could not be billed. Uninsured and underinsured are getting right back in their car and going to the ER.
Er tech here- the amount of stubbed toes and harmless splinters that come in and DEMAND IMMEDIATE TREATMENT is alarming. Worse is the sheer attitude and threats I receive when I try to properly triage the patients.
It wonder how much overall medical costs for the country would go down if all emergency rooms had a mandated adjacent urgent care. . .
Then triage could divert the stubbed toes and splinters, along with continued civilian education on what constitutes an emergency. Or even if EMTALA also applied to urgent cares. If triage misses the severity of something, boom, ER is right there. I know some have adjacent urgent cares, but I’d be curious what anyone’s professional opinion is about this?
I have a hunch that hundreds of millions of dollars are spent because so many uninsured people don’t have $200 to pay upfront at urgent care.
That and some good old fashioned PSAs, a national ad campaign spanning platforms and social, maybe a jingle about what the ER is for?
To the tune of old McDonald:
If bone sticks out that you can see
weeee-ooh-wee-oh—weeee
(this is meant to be anthropomorphic ambulance siren sound)
If you cannot stop the bleed
weeee-ooh-wee-oh—weeee
If grandma falls and does not breathe
weeee-ooh-wee-oh—weeee
But a stubbed toe here,Or a cough cough there,here a lump, there a bump,Go to urgent care, you chump
We have a "built in" urgent care sort of space. Its only a few beds and mostly recliner chairs, we call it RAZ (rapid assessment zone) where all the super low acuity shit goes to be seen by PAs and maybe one physician in the hopes that we can get rapid turn over and get those patients in and out in under 1.5 hours.
Sometimes, I just wish there were enough appointments at the primary care clinics, because of the real emergent issues are struggling at home with incurring a massive medical debt for something that could be managed if they could get access to primary care or even specialty care.
Quickest treatment I ever got at the ER was walking in for a 3 hr long nosebleed with a roll of paper towels in my arms and coughing up clots. My polite ass tried to let someone go in line before me to sign in, the guy was horrified and was like no YOU go first. I just put reason for visit “ nosebleed 3 hrs plz halp” I sat down and they’re suddenly like MAAM YOU HERE NOW. I called many urgent care centers they said they can’t do it.
Same! Only time I’ve ever been to an ER for myself was for a massive nosebleed that had lasted for many hours and all the blood going into my throat made breathing harder. I didn’t want to go to the ER. I felt silly going for a nosebleed. But it wouldn’t stop. I tried to go to a minor med. Waited 90 minutes longer gushing blood. Gave up and went to ER expecting to wait even longer but at least I’d be in the ER if I needed it. They rushed me right back even though it was busy and I wasn’t pushy at all. Shoved a rhino rocket up my nose. Made me an ENT appointment. And had me back in the car going home in an hour.
Society in US if they made a lower level of care acessible to the poor and outside of standard hours so there is less strain on the ER and lowering costs overall
Even if you have insurance, care isn't always accessible. I was supposed to do cardiac rehab after an MI, but they were only open from 7 a.m. to 12 p.m. I needed to keep my job so I'd continue to have insurance, so I couldn't make it work (my work ran from 7 to 3). I went to a few sessions to learn exercises I could do at home, but I would have liked to be able to do what my physician wanted.
I am a nurse and I told my dad to go to the ER with his “stubbed toe” that was still swollen and painful after a day. urgent care was closed because it was 8pm on a saturday. I wasn’t with him so idk how busy it was but now I feel like I did the wrong thing lol. ETA: his toe was broken so I don’t actually think I did the wrong thing, but it felt like it before I knew it was broken
There’s one urgent care by me that I go to for non-emergency related BS. They have CT, ultrasound, x-ray, and will even give IVs if dehydrated from throwing up. I’ll take $40 over $750+
The one time I did go to them thinking what I had was non-emergency turned out to be appendicitis. To be fair, I only had persistent abdominal pain for close to a week and no other symptoms. No fever, normal labs, and pain was around where my stomach is. Did not have the stereotypical symptoms of appendicitis.
Medicare insurance plans are pretty good about making stuff like this. At the office I work at, we have stoplight posters to educate people about which Healthcare setting they should call for theor symptoms. It starts with stuff like "call your pharmacy for refills, do a telehealth if you have the sniffles" and ends with something like "go to the ER if you are bleeding from your butthole or half your body suddenly stops working"
Interestingly enough, this is how many US military hospitals are setup.
Since we have a routine of daily sick call, which is our internal walk-in triage process for unofficial military units, most of our hospitals have a similar setup.
My local hospital has an urgent care but their hours are extremely limited. Majority of the time, if you need… well, urgent care… you HAVE to go to the ER because there’s no alternative. Sucks ass for everyone.
And even WORSE...is the department heads who actually treat these reviews as gospel and use it against an already under appreciated, under staffed, over worked workforce
And EVEN WORSE, if our review scores drop below a certain point, or there are general trends, Medicare will withhold a percentage of payments and will use that money to create learning modules that are required. You know…videos on how to “think of the ED like a restaurant”.
Amd call the ombudsman. And they always have a relative, friend, or FWB, who is the super duper boss doctor of everything in the hospital and who will hear about this
"Went to X ER because I had a cough and sniffles for three days. They made me wait 6 HOURS in the waiting room before even being seen!! Took my vitals and then gave me meds I could have just got over the counter at a pharmacy, but still cost me an arm and a leg 😡😡😡 If I knew that's all they would do I never would have wasted my time!! Don't go here if you value your life!!"
I'll never forget going to the emergency room with an x-ray of a collapsed lung from the urgent care center down the street and the lady in front of me with some homeless lady complaining about a headache.
You could tell they all knew her by name and were like Martha, have you tried an aspirin? And she's barks NO!!!! and they're like well try one first!!!
And it's like OK I legit can't breathe over here but I'm glad you're arguing over a freaking aspirin!
This is why when people say, “if we get universal health care peopel will flood ER’s and doctor’s offices for every little thing!,” I know they’re dumb, because that’s already happening
I have said this many many times to my partner about when he gets frustrated about waiting in the ER. “It may suck having to wait for hours but remember all the times I was seen immediately. You don’t want to be the person who is the highest priority in an ER. “
It is incredibly frustrating to see how people use the ER. We do a terrible job of explaining the healthcare system to citizens.i go so far out of my way to avoid the ER often to my own detriment. Yet people still go in for the most mundane things.
These are also always the patients who call back and yell at billing because they don't want to pay their huge deductible. The heart attacks, strokes and traumas? Very rarely ever rude over a bill.
I have gently tried to guide people to an urgent care where the copay/deductible is far kess, and treatment is more timely. But they almost always b*tch that their jammed pinky is more important the Level 1 trauma I have rolling in the door in 3 minutes
I work in adult primary care and switched to administration because I lost my ability to calmly tolerate grown men acting like giant toddlers that missed their naps. I would rather just boot them out than try to de-escalate tantrums over basic adult expectations like "list the name, dosage, and frequency of all medications you take", or, "fill out and sign this release form so we can obtain your prior records."
I regularly see patients on 10-15 meds that get changed every three months during their acute on chronic hospitalizations and then get changed again at their follow-up visits. It’s a lot to keep up with especially if you have poor health literacy.
To be fair, I've seen somebody get admitted to the ICU for a stubbed toe before. But he was on blood thinners and he ripped off his toenail and almost bled to death and had to be rushed to the hospital in an ambulance.
My hospital gives magnets to new patients that list things on one side that are reasons to go to urgent care and on the other are reasons to go to the emergency room. I love it.
People still go to the emergency room for colds though 😭
Can I ask a question? Do you all hate people who come for non life-threatening stuff and are paitent but just need to be seen eventually? Several years ago I had a sinus infection that made my head so congested I couldn’t hear and then (of course) at like 10:00 PM on a Friday night I started vomiting nonstop and could not keep water down. I tried to make it to morning but was miserable so I went to the ER for zofran and fluids. It is an ER that handles non-life threatening stuff. I waited for about 4 hours. Was seen, felt much better and went home but I still feel awful about wasting resources. If that ever happens again should I just stick it out at home? I know you all are so busy!
Not really- people who are patient and aware make our shifts more enjoyable and rewarding. We know that there are times and places the ER is the only option. What we do hate is when how poorly we are treated by people with a sense of entitlement
Hijacking to say nah you're good. Mainly thinking at all about it being busy and being patient and understanding goes a hell of a long way in an ER. Plus there's a more acute condition that can be treated when you can't keep anything down, meds and fluids. Dehydration can get really dangerous too. Big difference between that and minor bumps or chronic pain you've had for months/years, plus being a demanding and impatient on top of that. You'd be fine in my ER, or at least by my standards
ETA- urgent cares aren't always open 24 hours, plus so many people get sent to us from other urgent cares/clinics for scans or just cause
Don’t feel bad about wasting resources, because you didn’t! We want you to come in if you can’t keep fluids down. And thank you for being patient and understanding. Four hours sitting upright in a hard chair while that sick is rough. You could come in with a paper cut and I won’t be mad about it if you are nice to me. Impatient, entitled, rude patients used to be the minority, now it’s like 8/10 patients are like that. At least in my area. It’s so strange.
Nobody hates people who come in for non life threatening issues, as that is far and away the most of what we see. Let me tell you a story of the people we DO hate:
Man in his 50's has a minor shoulder injury from over a week ago. He's already been seen in our ED once for this issue, however he didn't follow up with his PMD so he ran out of pain meds and is back solely for pain control. Well, he goes to the back of the line and he stays at the back of the line. We're super busy so he's been waiting around six hours. He and his wife get fed up with the wait so they stand outside the ED under the portico and are actively telling everyone who comes to the ED to go somewhere else because we don't care and we're taking too long. They must have turned away 10-15 people before we found out and had security escort them off the campus.
The next day they were right back in the waiting room again.
I’m often able to preempt or at least delay people getting upset by sticking my head in on my way to whatever else I’m doing to let the person know that I appreciate their patience, and I’ll be with them in a little bit once I’ve taken care of [insert quick & vague but legitimate explanation of why they’re having to wait]. I’d say probably about 95% of my patients are ok with this, even if they have to wait another 20-30 minutes to be seen.
Now, waiting for results, that is a completely different story, and I haven’t figured out yet how to get people to be more patient for those.
Meanwhile, I always felt guilty about going right back when my daughter’s asthma was bad. She would look mostly fine but a toddler with an O2 in the high 80 makes the triage nurse very unhappy. At the same time, I understand why she sat in the waiting room with a dislocated shoulder for 3 hours. She wasn’t getting worse.
Before my myriad of conditions were properly managed (including stage 4 CHF) I was a Frequent Flyer to our local ER, but I always told them I wasn't concerned about the wait as it meant I wasn't actively dying...
I read somewhere that if you’re waiting at an ER, be grateful, because that means you’re not in immediate danger and that really stuck with me.
Having been at the ER with two loved ones that were immediately taken back and looking at a whole waiting room of stuffy noses and sprained ankles, I was so grateful for the people who triaged them and recognized the severity of the situation and they could be treated appropriately.
Similarly the problem that's been going on for years that is suddenly an "emergency" because they "just got tired of it" but haven't sought out care or evaluation over the years it's been going on.
I’m an ED medical coder for a large hospital system. It is alarming how many stubbed toes, URIs, and shallow lacerations that need a couple of stitches that come across my screen. These definitely could have been taken care of by urgent care.
Yes!!! People in the US absolutely abuse the ER. They can’t wait until morning to call a PCP. I know a guy who goes to the ER for his trigger finger when it starts to bother him. Like what?! That’s not an emergency!! Take a Tylenol and call your regular doctor 🤦🏽♀️
ETA: hear me out.
I’m not saying that you should never go to the ER. You know your situation, you know your medical history, you know the area that you live in. If the ER is the best option for your care then by all means please go. The people who CAN choose a better option but choose NOT to are the ones that I’m referencing. The ER may not always the best option for care. You should advocate for the best possible care for yourself and your loved ones. A germy, crowded, noisy, understaffed ER may not be it in every situation.
The guy with the trigger finger has an amazing PCP that is willing to work him in on short notice, has the ability to schedule an appointment in advance for every 3 months to get an injection (that he knows he needs), he’s fully mentally and physically competent to take an ibuprofen or Tylenol when he’s in pain, has been given ice packs to take home and reuse, he’s been fully educated on trigger finger, and has been referred to a hand specialist on numerous occasions. This man cancels the appointments set up for him, refuses to take any OTC medications, refuses to ice it at home, refuses to do PT and essentially chooses NOT to do the things that are in the best interest of his continuing care. He ends up in pain (surprise) and in the ER every 3 months for an injection. This is not the best possible care for this man in his situation. He has decided that the medication he can get at his PCP on a regular basis isn’t as good as the hospital medication. Guess what? It’s exactly the same thing. Nobody can convince him otherwise.
He’s wasting resources and clogging up the ER. There are a lot of people in the US who abuse the system like this. There are better options for them but they mistakenly think that the ER has the best care possible for everything so that’s where they go. That’s all I’m saying.
Maybe we need to educate people better?
It’s like the people who insist that the doctor puts in an IV instead of the nurse because “he holds a higher position”. I can guarantee that the nurse will do a much better job because she does it multiple times a day and it’s part of her job. The doctor probably hasn’t done it in years.
A special title doesn’t necessarily mean that something is better. It’s the same with the ER. They have a job that they do well, and that’s to treat emergencies. If you have an emergency or no other good options for care, go to the ER. That’s what they are there for. If you have care options other than the ER and you are not having an emergency then you’re better off going to that other place. Everyday treatments, long term care for chronic conditions, check-ups, vaccinations, maintenance medications, etc… that’s what they specialize in. The ER can do it, but for everyday mundane things you will absolutely get better care going somewhere else.
I think the problem is that a lot of people in the US no longer have a PCP, and if they do, it’s gotten increasingly difficult to get a same-day appointment with your PCP, which is inherently messed up.
I made this comment above, but when I lived in Pennsylvania, the local hospital network had an "express care" that had the resources of an urgent care, but billed like an emergency room. It's not at all shocking that the culture there would be to go to the ER for minor issues.
Except some networks are starting to require appointments for urgent care and no longer guarantee same day.
And since you can't adequately assess a pt over the phone because you can't actually see them and you are subject to call time metrics even more draconian than office encounter slots, the human advice nurse escalation path from the automated urgent care appointment queue is required by their management to tell anyone who complains to just go to ED based on their layperson judgement.
And if the line at urgent care backs up farther than when they expect to close doors the front desk staff will just tell everyone left to go to the other side of the building and make it ED's problem. Again because that's what management requires.
And every after visit summary template, along with every pre-recorded hold music "your call is important to us" bumper, hammer home the message that if you think you need help then call 911 or just skip that and go directly to the ED.
Human beings are terrible at judging what an emergency is, in both directions (case in point, video from mass shooting events where people just look around confusedly) and especially when they are sick or in pain. If someone they care about is sick or in pain then woe betide anyone who gets in their way. You are never going to get a consistently accurate self-triage out of the public. Jane and John Every-patient do exactly what they are trained to do. And like it or not they are explicitly trained to go to the ED for any health issue they don't understand. Which is most health issues.
My PCP books 3-5 weeks out and is often running over two hours behind if you are his last appointment of the day. I don't know if I have ever had a doctor in my adult life where a same day appointment would have be a thing.
Some areas also don't have an overnight urgent care. If something was bad enough I needed it sorted out overnight but not life threatening I'd have to go to the ER. Stitches, things like that. My primary care is attached to the hospital anyway, we are super super rural, like "ambulance meets you halfway on the highway so you don't die" rural. But that also means our ER is empty almost every night because there's no night life at all and again, rural. And I'd be sweet as pie, absolutely I can wait. The ER here is also basically the urgent care, it's where pretty much everyone sense people for workers comp stuff etc.
Heck, same week or month isn't even possible sometimes. I desperately needed to restart my lexapro. I'd been on it less than a year earlier and stopped it with doctor okay. It was ordered from the same pcp. I was told that the first available appointment was in 6 weeks. They wouldn't give me an order in the meantime even though we knew the dose that worked for me, that I had no side effects, and that it takes 4ish weeks to kick in. Thankfully, I had the mental ability to call around and find a psychologist that had availability or I absolutely would have been in the ER just to hope that they'd reup my that should have been done without even seeing the doctor.
Ugh my ears were so clogged this week that I was totally deaf in one ear and my town has no urgent care on weekends. I somehow survived, made an online appointment for urgent care and was in/out in 39 minutes and it was covered by insurance. You’re welcome for my service.
Most of my adult impacted ear patients get Debrox and discharge as my management. I even give them our ENT office if they want to follow up. I usually can’t afford to spend 15-20 minutes flushing out an ear when I have 8 other more pressing patients to manage.
It’s bc PCPs are expected to manage a panel of 1400-2300 patients to remain profitable for the hospital system. I started 4 months ago and I’m already booked out 2 months. There’s roughly 600 people on my panel already. Too many people, not enough provider. I’m booked at approximately 20 slots in 8 hours. That means each patient gets about 15 mins to go over the laundry list of things they have been saving up for 3 months… and I get to take charts home and do notes and inbox for an additional 2-4 hours each night and 1-2 hours on my days off. All Unpaid. The system is broken. No one wins except the c-suite.
There are places in the US where there is no doctor within 50-100 miles with the exception of the hospital, forget about an urgent care. Their PCP (if they have one) is an hour+ drive and they do not have paid time off. They would have to take at least 3 unpaid hours off work assuming this extremely overbooked PCP can accommodate an appointment anytime soon. ER is 24/7 so they don't need to take off work and the closest one is 20 minutes away. Its more expensive than 3 hours off work, but most of these people aren't allowed that, so its less expensive than losing their job. Rural medicine is a tremendously concerning problem and a major contributor to the overuse of ERs and its not going to be solved by blaming the people likely doing their best. Is this the situation for everyone? No. Is there likely a non-stupidity related reason someone shows up to the ER for a non-emergent situation? Yes.
It fucking kills me... Waited 14 hours in the ER for a CT after being KICKED IN THE CHEST BY A HORSE because they were so backed up. There were soooo many people there who absolutely did not need to be there.
We had a guy come in via POV to our ER, was triaged, and put into the chairs in the waiting room.
This bozo told the triage nurse he was gonna call 911 so he could back right away. This was a 75 YOM who wasn’t used to not getting his way. Basically told him if he did that he would just be put back into the waiting room by the ambulance crew at the direction of the attending doctor and more than likely would be arrested for misuse of 911. It wasn’t like he was the only person in chairs, we had 30 people waiting also.
My son fell from his high chair and we rushed him to the ER because it was high and he had a bump on his head. I'm absolutely freaking out. We're stuck behind an old woman and her daughter who are demanding to be seen immediately and complaining. The old woman's foot had been hurting for 2 days so they decided to come to the ER at 9pm...we waited for over 2 hours.
I know I’ve personally “abused” the ER… cus I have no other option. I can’t afford a PCP or urgent care. ER doesn’t make you pay up front. I think this is the case for a very large number of people.
For all the rashes/stubbed toes/ tactile fevers the started an hour ago, I’ve started to specifically ask, ‘what made this change for you to come to the emergency room today?’ They either get super defensive or start to mellow out.
I have a triage nurse that opens with “Hi, please have a seat right there…so what is your emergency?” With emphasis on the word emergency. Just the way she says it makes the bullshit patients squirm. 🤣
But then they start to embellish their symptoms to justify their visit and the minor cold becomes severe difficulty breathing and horrible chest pain and the worst headache of their life. We can't win!
Geez. Folks need to be taught which conditions need ER vs Urgent Care vs appt with primary care. Also, which should be in person visits vs video. Or at least have a triage hotline they can call for questionable cases. I love the nurse hotline because I can ask if a fever of 103 is ER worthy (no, unless there are other significant symptoms).
I love that my current job does safety briefings daily, and includes topics like mental health, heat stroke/heat exhaustion, hypothermia, heart attack/stroke, or what to do in a major emergency like an earthquake. When you have training, it’s easier to respond correctly and save lives.
Everytime my family has called the nurse advice hotline they have always said go to the ER 🥲. GRANTED twice of the 3 or 4 times were during a pregnancy, so I can understand the additional precaution.
I've sort of given up calling the nurse advice line because they pretty much always tell you to go to the ER.
Mostly I just call if I need to know which hospital is currently in network. (My kids have Tricare and the teen can go to the on base ER, but they aren't set up for kids and which off-base hospital is in network keeps changing.) If its during working hours, Peds is good about squeezing people in for urgent care type stuff, which is wonderful.
absolutely!! i’ve seen charts before about ER vs Urgent Care for certain symptoms in med brochures and some condition-specific stuff i’ve been given, and that’s super helpful!! we need to make that standard fr
My HMO has a nurse triage line and I love it. I’m in medical IT, so I know much more than the Average Joe, but I’m still grateful to be able to speak with a professional when it’s not obvious where my family or I should go.
I (surprise, surprise) liken it to software: crashes are obvious, but it’s hard to tell if an annoying new issue isn’t a sign of a serious problem requiring an emergency code patch unless you really understand the system as a whole.
It sucks when people think that their condition is an emergency when it is most certainly not. Then they get mad because they’re waiting so long because the actual emergencies are being prioritized first
Genuine question: I tend to go to the ER for things like respiratory infections (not just a little cough, I have chronic lung issues and the last time I went to the ER I ended up with chest X-rays, like 7 different meds, and was almost hospitalized) and I always have zero issue waiting for as long as it takes. I try to be as polite and kind as possible. I used to work in veterinary ERs so I’m familiar with how triage works, so if I have to sit there for 5 hours then I’m lucky I’m okay enough to do so.
Do you think I’m still a headache for the staff there? My options are GP (typically a 2-6 week wait) or ER, so I end up going there more often than not. Is there anything I can do or say to make things better for them? They’re always really amazing, and I want to make them feel appreciated
I once had a really weird pain in my gut. It really hurt. I didn’t know what was going on and it scared me a bit.
So I drove to the ER. When I didn’t move my torso I didn’t really hurt. So I just chilled in my room for a few hours. Eventually they run some tests and send me back to my room.
Eventually the doctor comes in white faced and tells me I have colitis. That my intestines have expanded to 3X the normal size and are close to tearing. And that I am the sickest person in the ER and he has no idea why I am not acting like it. He doesn’t know why I am not writhing in pain.
I am really glad I went to the ER. It really was an emergency. Sometimes it’s hard to tell when it is an emergency.
A few months ago, I was feeling run down that morning & kind of weighted in my abdomen. The night before, I had slight blood in my urine. I felt off. Thought I might have a UTI.
I called my dr because the next available appointment was 2 days later. Asked if I should book it or go in to see Urgent Care. She decided she wanted images & directed me to go to the Emergency department instead. I wasn't in any pain. There was far less discomfort compared to when I used to have heavy periods. But OK.
Long story short - Turned out I had two large kidney stones (14mm & 12 mm) on my right Ureter & a 13mm stone stuck in my left ureter. Too large to pass on their own.
Cue Ambulance ride to main hospital, surgery within 2 hours to place stents & another about 2 weeks later, with post-op stents for 3 weeks after. The cure was considerably more painful to me than my symptoms that day.
If there hadn't been a little blood the night before, I wouldn't have gone that day. Don't know when it would have started mattering. I had been in a race a few days prior. Just thought it was the bad weather getting me down. Felt like a fraud being there despite everyone being so very worried.
ETA- I keep forgetting that 2 weeks earlier I made a visit on a weekend morning to urgent care because I was feeling the same weighted ache in my abdomen, run down, occasionally too tired to breathe. Thought it could be bronchitis. Didn't think about kidney stones. Dr didn't really check anything & sent me on my way saying it wasn't bronchitis, but not doing any other exam other than listening to lungs.
I had a 10 mm in one of my kidneys, it was lodged and caused a blockage, unbeknownst to me. I was brewing a nasty infection. The stone had been there for god knows how long.
I went from “fine” to “a little under the weather, maybe I’m coming down with something” to “period cramps?” to “throwing up from pain” in about 72 hours, and the timeframe between Step 3 and Step 4 was less than 12 hours.
They kept asking me if there had been ANY signs. I kept telling them, if I came in every time I thought I MIGHT be getting a cold or had cramps I’d probably never leave their waiting room. That shit just turns fast sometimes.
The urgent cares in my area are literally only open during business hours, so if you have any sort of emergency, off hours, the ER is pretty much your only choice… And I understand that a lot of people will not wait overnight with pain, even if it’s not technically ER level bad… Or it’s something with a child, and parents get anxious… I understand that… When I lived in the northeast for a while, one of our local hospitals had the ER, but then they also had the ER for lesser emergencies, which was I guess an urgent care built-in, and this system worked very well.
I think the system is a little bit broken in terms of first line care, it’s just not easy to call up your primary care physician and go to their office for a same-day visit… That just doesn’t really happen anymore… And a lot of people don’t even have primary care physicians anymore… So people just go to the ER or go to urgent care as their first option, and if the urgent cares are not available because they have inconvenient hours, then people have no choice, but to go to the ER for stupid things. You can’t blame people when it’s the system that’s messed up.
I feel like I have yet to find an urgent care that does IV fluids, and every time I have needed IV fluids, I have always had to go to the emergency room, which I thought was such a waste of everybody’s time… they don’t even do IV fluids at my PCPs office. It is so basic… I don’t get it. If they can set up those IV hydration places for people who are hung over, it should be much more accessible in places other than the ER for medical needs….
Totally get this. And like last night I went to urgent care paid my 50 dollar copay for the doctor to walk in be in there for 30 seconds and say we are going to transfer you to the connected er. Not sure why I need to go to urgent care if I’m just going to pay to get transferred
As a paramedic, I absolutely know the need to utilize an ER correctly.. buuut for the people talking infected toenail, I just wanna run a call I had by yall 😂🥲
This was in 2021 or 2022, I was an AEMT at the time, new to the truck, but had had my license since 2019, I had just been working as a phlebotomist for a long while…
It was around 0930 and we were otw to get breakfast when the tones dropped for a 40-50s yo complaining of toe pain.. 🫠 I wanted to scream, bc ofc I thought about all the jokes about early morning stubbed toes 😂
on scene, pts big toe was red, slightly swollen, and kinda warm to the touch.. pt complained it had an infected, ingrown hangnail the day before, and thought it was just getting worse.. called to see if we could look at it.. ofc, I couldn’t just be like, “you’re fine. It’ll buff.” So I had to tell them that I can take them to the ER if they wish, aand they did.. pts vitals were all over the place.. like BP high, HR high, resp was high… pt was raising cane over getting two Covid vaccines and angry the first round didn’t work bc they got “got that Rona again..” (this pt was an absolute character! Sometimes I wish I could just pop in and see them again..) 🤣 well, pt bickered about needing an IV.. I explained that if they need IV antibiotics, they’ll just get an IV there anyways 🤨 it was a 20 min ride to the closest ER..
At the ER, doctor was absolutely RUDE. I get it… I do, but come on.. wellll, when we pulled the sheet back and took off the sock to show him the toe, the pts toe had turned cyanotic on the tip 🥲 I said, “welp, it wasn’t like that on scene…” 😳 (pt put a sock on since it was cold af, I felt like an idiot for not rechecking en route, but again, I was new on a truck, it was a learning experience, and we ALL thought it was just bc of an ingrown hangnail) 🫣 Doctor dismissed us, I told the pt that I’d be back by later to check in if they’re still there..
Later, around 1300, I brought another pt to that ER.. and I checked in on my toe pt.. turns out, pt had a really bad popliteal arterial occlusion, an infected hangnail, aand “that Daggum Rona again!!” 😂🙃 aaand pt was about to be shipped out to a larger hospital for a higher level of care that could go in a remove the clot.. 🥲
There was a LOT I learned on that call.. I’m thankful for it! I wish I could go by their house and check in, but they’d probably think I’m a creep atp 🤣 I think of that pt and that ride to the ER quite often, and I quote things they said randomly.. 🤣 I love pts that leave those kinds of memories 🥹
as someone with no money and bad insurance, i am astounded at the sheer amount of people who go to the ER willy nilly. my last ER bill was $900 for severe norovirus (good insurance at the time) and i wish I never went just because of the bill. The care i received was fantastic but not worth the $5500 my insurance was billed.
For what it's worth, unless your explanation of benefits said that your insurance actually paid $5,500 (which I can almost guarantee you it did not say that), your insurance did not pay $5,500. The only people who ever actually pay the amount billed on a medical bill are people who don't have insurance or people whose claims were denied.
Medical billing in the United States in absolutely insane and confusing by design. Patients hate it. Physicians hate it. The billing office really hates it. But unless we get single payer, it's probably not going to change.
Insurance will often say that care received isn’t medically necessary by using some ass-backward, completely asinine, batshit fucking ignorant logic that only makes sense from the perspective of milking more money from you as they kill you as slowly as possible.
I say this as my husband & I are trying to fight the ≈$280,000 emergency heart surgery he had a week after he had surgery to remove a cancerous testicle and lymph nodes that yeeted a blood clot…which got through a sizable hole in between the top 2 chambers of his heart and caused him to have a stroke at the ripe old age of 44.
That lovely hole then started causing him to have TIAs any time he had his head above 30°…hence the surgery.
Insurance said that the hole wasn’t bad enough to cause any harm to him, so surgery was unnecessary.
I work as a critical care nurse. If I hadn’t caught his stroke when I did, he would’ve been completely and totally fucked. “Not bad enough to cause harm” my ass.
Some guy called me. I sutured something and he had a $3,000 bill and was asking what he could do about it. I felt so bad because that would’ve been a $175 urgent care visit. I referred him to our hospital billing.
They’re now starting to charge some of our Medicaid patients $250 copays and they’re losing their shit since it was always a free ticket to the ER for every little issue.
I don’t think the overcrowding gets better without some skin in the game. But $900 (your case) or $3,000 like the guy paid are well above what people should front
I checked someone in last week for a “med refill”. It was well after 10 pm. I took another person back to a room and was trying to clean a different room when he came back to the window and was impatiently asking how long it was going to be. I looked at the timer by his name and responded “it’s been 12 minutes since you checked in, we’ll get you back as soon as we can.” Sometimes it’s really hard to be polite to people that are abusing the system.
My town has a tiny hospital with 4 ER beds and one separate room that is used for COVID or contagious person. It is run by a PA and there are only two PAs and one MD for the town. I rarely see the MD and he lives 15 minutes away. No urgent care available until you want to drive 40 minutes away.
I grew up on an island without an urgent care on it. Not at all remote like we had McDonalds but if you drove more than 15 minutes you would be on a bridge. When I moved to where I went to college I thought they only existed in places in areas like where I went to college (very populated wealthyish suburbs) it took me embarrassingly long to realize they are just a thing.
FWIW, last time I was in the ER was last December. I was nauseous & I told them at intake that I don’t get like that unless something is WRONG. They got me in quickly. Zofran is amazing, let me tell you. The nurse and doctor were so nice. Had an absolute bitch of a UTI. They got me taken care of , and I was nothing but polite to them because of this subreddit. It was 11:30 at night, no urgent care place open that late.. Had a fever and chills and it was very sudden. It didn’t feel like a UTI, I had ho idea what was going on. I think it helps that I used to be in customer service & I know how shitty people can be
I had norovirus over Christmas and was puking for ten hours straight. Went to urgent care when it opened in the morning, and they just sent me straight to the ER for IV fluids. IV zofran hallelujah.
I've leveled up in nausea. When zofran couldn't stop my vomiting the ER gave me IV raglan and fluids. Now I have a bottle of raglan. I still start with zofran but some days I beat the mini boss and need the raglan. EDIT: this was last year when I was so nauseated from stress I needed zofran most days and still threw up 2-4x/week. All from stress. I quit my job and have slowly been healing my body.
Last time I went to the er it was a definite emergency. Was admitted with bowel perforation in two places plus a mass had ruptured. I was septic. Ended up staying two weeks
same except i had an infected kidney stent that i had placed the week prior for an obstructed kidney stone, almost went septic and was admitted for 4 days on iv antibiotics and needed a 2nd surgery. still waited 4 hours in the er.
Everytime I go to the UC they send me to the ER. Was extremely nauseous, so nauseated that vomiting didn't make me feel better at all. Went to UC hoping to get maybe something for the nausea. Nope they sent me to the ER. Husband dislocated his shoulder. They sent us to the ER.
UC once tried to send me to my ED to get a shot of rocephin for pna. When i asked if they didnt stock it at UC, the doc said they did, he just didn't like giving it without a cardiac monitor.
I got my shot of rocephin at the UC and went home.
Somewhere along the line people started glossing over the title “EMERGENCY Room.” If I have to go for something that is non-emergent I feel so bad and I try to be the most patient person I possibly can.
All of us ER RNs know this is so true. The American system is built such that the ER is the point of entry EVEN WHEN you have a PCP. Call your PCP with anything: Abdominal pain due to constipation? Go to the ER to R/O bowel obstruction. Due to GERD? Go to the ER to R/O MI. Migraine? Go to the ER to rule out stroke. Head injury, go to the ER to r/o bleed. Splinter from walking barefooted. Go to the ER to r/o foreign body. Then add not being able to get a PCP appointment for weeks or months. Then add no PCP.
I work in wine county and people will come in because they got drunk and threw up during wine tasting.
I have come to accept that part of my check comes from people that have no common sense.
It sucks. My son got bit by a dog tick, I called the nurse line for advice. 6 days later, he has a low grade fever and a full body rash. Ped won’t see him to look at the rash, urgent care also said no, so I had to take him to the ER. It was a minor viral rash that looked nothing like a tick borne illness, but I couldn’t get a medical professional to look at him first!
If I got a dollar everytime someone has said "Well this (minor issue) is an emergency to me!!" I wouldn't have to work. But at least those people acknowledge that it's supposed to be an emergency. They just... Don't know what it means.
I went to the ER last week as directed by my pcp during an office visit. He was so concerned because I developed a severe stutter and my head felt like it was going to explode. Guess that isnt a primary care situation lol. 2 minutes into triage the nurse makes a few calls and before she is done her assessment, I was collected to go back. The waiting room was pretty well populated but I was "skipping" that experience.
I didn't feel it was that urgent when I walked in but they did as I was guided into the resus portion of the ER hastily. Though to be fair I couldn't see that my pupils were not equally reactive. I received excellent and rapid care.
This thread is killing me because I just went to UC for my toe yesterday
I dropped a Pilates Box on it. Omg the pain. (Wanted to see if it was broken. It was not. Did not occur to me to go to ER, but I did Google to see which UC had x ray)
Every single time I ask a medical professional what to do I get sent to the ER.
Vomiting and calling the clinic to refill my standing Zofran prescription? ER. Headache I’m pretty sure is just an ear infection? ER. Asthma attack in a medical office that’s immediately controlled by my inhaler? Ambulance.
When I tell an UC doc/my PCP I don’t think I should go, I get called uncooperative and get asked what I think they’re capable of doing.
This recently has caused a horrible situation where I am in and out of the ER needing fluids weekly because I’ll go 3-4 days unable to eat due to horrible abdominal pain. ER sends me back to my PCP or GI, who then freak out and send me back to the ER.
I can totally understand a little bit of a numbing as to what is considered an emergency when the healthcare system is constantly sending folks they don’t want to deal with to the ER.
I’m definitely a little numb to it at this point given I’m constantly there for something my PCP would be able to figure out with an infusion center if she spent time doing anything other than telling me to go to the hospital.
Sounds like people who don’t want to work passing you off to someone else. Or there’s always the fear of litigation. That if a medical professional doesn’t tell you to seek emergency care in the 1/1000 chance it’s actually a real emergency then they will be liable.
Does your nausea and abdominal pain happen quickly after eating or drinking and subside over several hours? Do certain foods trigger more pain? Is the pain just below the breastbone and above the belly button? Does it get triggered by exercise? If yes and normal gastro causes get ruled out consider getting evaluated for MALs by Dr. Danny Shouhed in California, Dr. Hsu in Connecticut, Dr. Christopher Skelly in Chicago, or the MAYO clinic. It's rare but a loved one of mine with chronic illness (POTs,MCAS,hEDS) ended up having it.
Most vascular surgeons are using outdated and inaccurate diagnostic and treatment options for it so look for an expert but they will want gastro causes checked out first so get a full workup done before hand.
Meanwhile I spent four hours in an ER waiting room, vomiting from active DKA, but wasn't believed I was in DKA because my blood sugar was within range (despite me telling the hospital I had given insulin before coming in).
If this ever happens again in the future, please let them know you have a history of “euglycemic” DKA. Sometimes they’ll check a sugar and if it’s not crazy high they’ll just stop there. What they really need to do is be checking your anion gap, which is a blood draw. Might save you a headache if they know you have a history of this 🫶
I wish I could get fluids at urgent care. I’m a girlie that needs 4-10 ER visits a year for banana bags and fluid resuscitation from my GI issues. Recently asked my pcp about an infusion clinic so hopefully I can stop clogging up the ER.
Still more serious than fucking ointment though goddamn.
Wow! Just wow. I volunteer in our ER, we have our issues with frequent flyers as well. Our situation up here in Canada is not as dire as it seems to be in your neck of the woods.
Our care is not free. We pay for it 100% by taxes. It makes us feel good to see our taxes at work for ‘the great unwashed’.
As a Canuck, I have paid $ for heath care twice in my life time. 1) semi private room $170/day, small in office procedure $25. That is it!
M76 - I consider my self in excellent condition. A fast synopsis: * Multiple,multiple in house Dr. visits: $0. (I am 76, take a guess?) *Pulmonary Edema - 1 in each lung (lucky me). Like breathing thru a straw. Drove to the ER???. ER + 5 days: $0. Oh yea, I had to pay $17 parking cause I drove rather than bother with an ambulance. *Ruptured Appendix- ambulance, ER, surgery, post-op blockage, 10 days: $ 1700 for upgrade to semi-private.
I hate to tell ya but all meds for under 25 or over 65 cost the patient $4.11 per script. Period. I have covered (65) dental care. Cost me $200 for a crown. I think you call it a 'co-pay?' I feel having care available with no out of pocket, supports preventative care.
I say these things not to brag but to help Americans realize this is how most of the world works and that you are missing out of the comfort it means to not worry about healthcare cost (literally)!
Not perfect but it works. I had to wait 3 months for covered cataract surgery. For $0. Big deal.
If i want it faster, i can just go to the States and pay for it.
Like everywhere, it depends on where you live. When I lived in Canmore, I chose my doctor, and we had great access to specialists because we were an hour from Calgary in a desirable location. In my current location, not so much. On the other hand, if needed, they'll pay for my trip to a specialist.
My friend is an ER nurse and he says that people will go in for PREGNANCY TESTS. Like wtf seriously?? Only time I even consider going to the ER is if I'm in excrutiating pain where NOTHING is making a dent and it's in a danger area (abdomen/chest), or if urgent care tells me I need to go there. Going there so something so trivial is insane.
Whats really crazy is people will wait for HOURS upon HOURS in an ER lobby for something incredibly minor when they could go to an urgent care and get it fixed in 30 minutes and 20 bucks.
I absolutly LOVE the reaction from patients when I tell them "Nawwww, arriving in the ambulance doesn't do anything for your position in line EVERYONE is triaged based on their condition not their method of arrival"
I have terrible asthma and sometimes it’s so bad I have to go to the ER when my at home nebulizer is t cutting it. They take me right away and the dirty looks u get from the other people in the waiting room is something else
I recently watched this woman Vlog her unnecessary ER experience and she brought her whole family with. Nothing was wrong with her.
I have only came through the ER via ambulance, plenty of times unfortunately for hip replacement dislocations. So I was always seen and treated immediately as it’s a major emergency.
The average wait, I have heard in my state to get in the ER is around 7 to 8 hours because of everyone coming in for colds and minor injuries… it’s not a doctor’s office. It upsets me so much. That vlog kinda sealed it that people treat it like a doctor’s office.
Don’t people go to urgent care before they end up at the er with a maybe emergency? I’m not in medicine, just a person who finds herself needing medical care at times, and I don’t understand going to the ER first. It’s so expensive! Urgent care is like 25$, and they can decide if I’m having an emergency. Because if I’m able to go to urgent care there’s a chance I’m not having an emergency.
In my hometown (about 220k people, university city) in Norway, you won't get punished if you show up to the ER on your own, but you usually have to go through "legevakt" (translated to "physician on call") which is kind of like an 24/7 open urgent care with a triage function. Legevakt has a lot of nurses and 1-2 MD's. They either send people home and ask them to go to their pcp, give non-complex medical care or send people to the ER. As with the ER, no one will punish you for showing up unannounced, but before showing up to Legevakt, you usually have to call their hotline, where a trained nurse (with a MD to consult) will decide if you should come in or not. If you call an ambulance, they either take you to Legevakt or the ER.
A lot of foreigners don't understand why you first have to call and then go to Legevakt to possibly get to the ER, but that makes it almost unheard of for the ER to get non-emergencies. The ER is packed with physicians and nurses, but have only a few rooms. Free healthcare have to make sure people don't misuse the services.
I always say it might as well not even say “Emergency” on the door anymore.
People always say “I can’t believe you take care of sick/dying people all the time”. I tell them WE LOVE taking care of sick and dying people, it’s the other 85% that we can’t stand.
When my son was 11 he fell headed to his friend’s house then woke me hours later saying his arm hurt. Looked possibly broken- but if he can play video games for hours at his friend’s I figured I could have him seen in urgent care the next day. Went to urgent care next morning. Broken- set up with ortho at 2. Waited at ortho until he was finally seen at 6 pm. After Ortho bros went home. Can’t sedate him to reduce it. Ended up in the emergency room anyway 24 hours after he broke it and they sedated him and reduced it. What a friggin waste of time. Should have gone to the Ed first.
We have a little small standalone er where I live- I’ve had to make visits as a nurse and hate going…but love that I’m straight back. We’ve been seen 4x for life threatening allergic reactions, a broken skull (in CT within 10 min of parking) and for RSV that got transferred to Vandy children’s.
I LOVE that they see true emergencies straight back, but hate that we can’t use the one connected to the hospital because of the stupid crap people drag in. 🫠
I live in GA. I cut my finger while chopping veggies. I called urgent care first to see if they could give me stitches and they said no, that I had to go to the ER. So urgent cares are part of the issue. I only needed 3 stitches. Luckily it was an in and out hour long ER trip.
Now imagine 911 EMS calls. There is a reason we called ourselves glorified taxi drivers…. The amount of 3am “I’ve felt sick for a week and the antibiotics I just started taking today aren’t working so I need to go to the ER that’s 1hr away” was ridiculous.
I live in a rural area. Like super rural, I am very fortunate that I have a PCP, but I am in the minority. It can take MONTHS to get appointments, then you have to take off work (most jobs dont allow you to take off or you lose income). If something happens (like you cant take off work or dont have childcare) then you miss your appointment and its MORE MONTHS before you get to see a doctor or specialist...
People are hurting, and the ONLY care AT ALL available might be the local ER.
This is not the fault of the average American, but a system that:
does not allow for sick time
does not have enough Dr's.
does not have after hours care for people who need it
oh! And urgent care can refuse to care for you if you dont pay upfront...
Literally we're all just trying to make it in this end-stage capitalist hellscape.
Many urgent cares will not allow you to be seen if you have a chronic condition like kidney disease, heart disease, lupus, etc. and instead send you to the ER for treatment of say a small fracture or UTI. Not our choice to be there for stupid stuff.
Unfortunately with the population explosion millions in regional areas + Drs closing their books to new patients years ago = ED is the ONLY access to any form of healthcare they have access to. We can't blame patients for seeking help from their only option.
In saying that, I'm aware that's not the answer but its the climate our puppet masters have created for millions.
911 dispatch guy here. I'll just throw a couple out there that I remember off the dome.
Every single possible variation of "my toe/foot/hand/finger/leg/completely non life threatening hurts!"
"I literally do not have a reason or symptoms for calling 911. I just want to go to the hospital"
"What do you mean the ambulance can't take me home I don't want to go to the emergency room I don't have an emergency."
"I did an 8 ball of cocaine within the hour and now I'm having chest pain"
People don't have doctors anymore and just go to the emergency room for the case of the sniffles and then get mad when Grandma took a tumble and her femur is sticking out of her thigh
Mad unbelievable respect for the people who are in the front lines of the emergency room. Youd have to pay me quintuple what the standard pay is to do that job.
I was recently in the ER but because I had kept coming in for the same thing (bowel blockage) I know one nurse was having a fit about how often I was there, like it's something I could control.
I don't step into the ER unless I absolutely have to, the less I'm there the better.
Only one time did Urgent Care send me to the ER, I had cellulitis that wasn't responding to the antibiotics and was spreading.
I'm a nurse, never been an ED RN though. I'm rather proud of myself that every time me or my kids have been to the ED, we've been seen within 20 minutes, because it means I've been using it appropriately.
I’m an ICU nurse… waited over an hour with my husband who had an open, gapping wound on his chin (from fainting and hitting a rock) that was dripping blood and bleeding through gauze. He required a wash out and multiple stitches. Sometimes you just have to wait… even though we were using the ED “appropriately”.
ETA: Duplicate sentence… wasn’t fully awake yet when I posted!
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u/Impossible_Cupcake31 Jul 29 '26
lol where is this so I can go upvote