Emergency or urgent care? Where and when should I go?

Have you been to the ER in a hospital and waited there for hours for attention because your problem wasn’t as severe as others? Have you felt ill without knowing whom to call or where to go in order to get help? Do you feel that emergency services are the only option available to you? Well, you are not alone because many people answer “yes†to these questions. A recent study by the Centers for Disease Control (CDC) from January through June 2011 found that 79% of all adults between the ages of 18 and 64 who used hospital emergency services without having to be admitted to the hospital did so because either they didn’t have or believed they didn’t have another option. The study also confirmed that people of Hispanic origin tend to use emergency services in hospitals more than other minority groups.

Hospital emergency rooms must be prepared to treat a variety of serious problems and therefore must have on hand expensive equipment and specialized staff. They use a “triage†system to insure that people with life-threatening injuries or illnesses are seen first, which leads to long waits for those whose problems are more routine. ER services are, necessarily, much more expensive than other services and therefore the misuse of the ER leads to higher health care costs across the entire health system. In Massachusetts, community health centers have been creating alternative solutions to this problem. They are establishing “urgent care†services that offer prompt medical attention to all those who need to be seen “same day†but do not require intensive specialized care. This is the case of the South End Community Health Center, which recently inaugurated this service and offers prompt, high-quality medical attention. To learn more about the problem of the overuse of emergency rooms and the comparative advantages of urgent care services, we interviewed Dr. Pablo Hernandez, the Medical Director of this institution.

Why do people go to Hospital ERs in order to find solutions for routine problems?

In part, in the past it had to do with the absence of medical insurance, although in the state of Massachusetts around 90% of the population either already has medical insurance or they have assured access to primary medical care.

However, what people think about medical attention seems to be more important now. Historically there has been either a resistance to or difficulty in making appointments with doctors and this has led people to use ERs for immediate attention. People call their doctor and ask for an appointment “tomorrow†and the answer they receive is “not tomorrow, but in three weeks.†Or they wait until the problem is too big to tolerate and then they need to go to an ER when they might have been treated by their PCP or in an urgent care service while the problem was still smaller. We have to try to change this pattern because the costs of emergency attention can be three times or more than those of going to your primary care physician.

What is the difference between “urgent care†and an “emergency room�

Emergency room services are found mainly in hospitals and rely on all possible services: x-rays, MRIs, lab testing and medical specialists. The priority are cases of life and death: heart attack, stroke, car accidents, etc. An urgent care unit may not have all of these services but most people don’t in reality require them. They take care of cases that are not life threatening and do not need an ambulance. These may be an ache, fever, some common urinary infections, pneumonia, conjunctivitis, problems of the skin and allergies, among others. They even can carry out minor surgeries.

Can any person come here if he/she feels ill and couldn’t reach or be taken care of by his/her primary doctor?

Yes, anybody will be looked after and the waiting time is shorter than in an emergency room. In addition, we serve as a bridge between the patient and his primary care physician. We immediately communicate with the PCP and ask for the insurance referral needed so that the patient can receive the service.

What if a person doesn’t have health insurance? What about immigration status?

Your immigration status is of no importance. If you don’t have insurance you can be seen in an urgent care service anyway because they provide insurance counselors whose job it is to help you get insurance and tell you your options. We are focused on caring for our patients. If a person doesn’t qualify for insurance we can still give him medical attention for a very, very reduced price.

Here in the South End, is this Urgent Care service open every day?

We are open from Monday to Friday between 8:00 a.m. and 5:00 p.m., and on Saturdays the clinic is open between 8:00 a.m. and 12 p.m.

Is there a cultural aspect that leads people to trust hospitals more instead of community health centers?

In Latin America people tend to go to hospitals because the community health centers are ill equipped, especially in non-urban or rural areas. However, the quality of service offered in community health centers is as good as in hospitals and in some ways it is better. People see this because these centers are more welcoming and are located in the neighborhood they serve. They are more familiar and there is a closer relationship with the doctor. Although sometimes we have to rely on medical interpreters, many of our staff are bilingual. This goes further than just the language: Because we have a cultural focus, we understand the culture of the patient. Community health centers, which have always been at the forefront in taking care of the needs of the community, are forming an alliance to establish “urgent care†services. With them we can provide excellent medical attention and reduce both costs and time spent waiting.

To find a community health center near you go to: http://www.massleague.org/findahealthcenter/index.php for information in English and Spanish.