Emergency Room, Urgent Care or Primary Care Physician?

It's 2 a.m., and you wake up with a terrible pain in your lower back. It's 5 p.m. on a Sunday afternoon and you suddenly feel extremely nauseous. It's 9 a.m. on a Wednesday morning and that cough that's been bothering you for a couple days suddenly seems to take a turn for the worse. What should you do in any and all of these situations? Should you visit the emergency room? Can you get an appointment with your primary care doctor? What about those urgent care centers that are popping up all over the place? Where can you be seen in the most timely manner and get the most appropriate care for whichever health issue you're facing?

It can be a tricky question to answer, especially when you're making it under duress and without the benefit of a medical degree to help guide you. Dr. Douglas Kupas, an emergency physician and EMS physician at Geisinger in Danville, Pennsylvania, says there are several factors you need to take into consideration when choosing where to go for health care in various situations. The most important is "the type of injury or illness that you have, its severity and whether it fits with the resources at the site."

[See: 10 Questions Doctors Wish Their Patients Would Ask.]

There are pros and cons associated with each provider:

-- An emergency department likely offers the most resources and is able to handle virtually any medical problem that comes in. Most emergency departments are also attached to a hospital and can admit you directly if you need surgery or other critical intervention.

-- An urgent care center may have an X-ray machine and/or the ability to perform some lab tests, but may need to transport you to an emergency department if the severity of the issue is beyond the scope of its services.

-- Your primary care provider likely knows you and your medical history best, but may not be able to handle acute problems that require more advanced care as fast as an emergency department or urgent care center.

In addition to thinking about the resources your medical condition may require, you should find out whether your insurance is accepted at any of these locations. And there's a convenience factor with accessing these different kinds of care -- your primary care physician may not be available in the middle of the night. But getting to the right place in a timely manner may be critical to survival. "It's a combination of where can I get in quicker, but also where can I get in quicker to the right place at the first time, because if you go to the wrong place, you might get quick service but have to be transferred on," Kupas says.

Each health care provider is best suited to handle various conditions. Here's a run-down.

Primary Care

"The primary care physician is generally someone you establish a relationship with who hopefully takes care of your ongoing medical needs," says Dr. Jay Ladde, associate program director and professor of emergency medicine at Orlando Health. "The primary care physician also serves as a surrogate to connect you with other health care providers. So, if you need a cardiologist or an orthopedic surgeon, you've got one physician [the primary care physician] who's managing your care, understands your ongoing problems and expedites your care," he says.

Dr. Tania Elliott, chief medical officer at EHE, a New York City--based healthcare management company dedicated to prevention, agrees that a primary care physician is an important health care ally you should visit for ongoing medical concerns. "If you have a chronic medical condition which requires regular follow-up, your primary care physician is the way to go."

This is in part because the primary care doctor offers continuity of care. "For things you need to continuously follow up with or a chronic issue that's coming and going," visiting your primary care physician is the best bet, Kupas says. In addition to routine check-ups, prescription refills and ongoing health management for chronic conditions like diabetes or high blood pressure, your PCP can also see you for acute problems like bronchitis or coughs and colds.

"When you go to urgent care or the emergency room, the care is episodic, meaning that no one is really keeping track of your visits, medical problems, prescriptions or medical conditions the way that your primary care physician would," Elliott says. But if you have a PCP with whom you can develop a relationship that can help minimize overtesting, medical errors and unnecessary tests and procedures.

Elliott says finding out whether your primary care doctor can see you in a pinch ahead of time can make dealing with an acute issue if it pops up a little easier. "When choosing a primary care doctor, find out their policy on sick visits and follow-up visits to make sure they can get you in when you need them." She also recommends minimizing doctor-hopping. "When one healthcare professional doesn't have insight into care you may have previously received, it can lead to an incorrect diagnosis or over-diagnosis and very high costs."

[See: HIPAA: Protecting Your Health Information.]

Urgent Care

"Urgent care is good for episodic, but minor things and convenience," if you can't get into your primary care because it's after hours or the weekend, Kupas says. Ladde adds urgent care can serve as a sort of "intermediary between the primary care physician and the emergency room." These providers may be able to deliver care faster than your PCP in some cases, but may not offer as many options as the emergency department.

Examples of specific problems urgent care centers are well suited to handle include "minor insect bites and stings, sprains and strains, coughs and colds and minor wound care,"Kupas says. "Urgent care is also good for getting a school physical form filled out or flu shots and immunizations," he says.

Elliott says "urgent care is meant for non-emergency conditions." These conditions "may require an intervention or minor procedure such as stitches, X-rays, or evaluation of musculoskeletal injuries. We call these 'one and done' types of visits, that don't really require major follow-up," she says.

If you're in doubt, but can make contact with your primary care physician, Kupas recommends calling that doctor for guidance on whether you should wait to see him or her or if you should visit an urgent care center.

Emergency Department

"Emergency care is meant for true medical emergencies that would require hospitalization or surgery," Elliott says. "The most common causes are chest pain, severe abdominal pain, major trauma, suicide attempts, motor vehicle accidents and uncontrolled bleeding."

"I think most patients who are unstable or having conditions or symptoms" that could potentially "kill them or leave them in significantly bad shape if not addressed more immediately," that's when you go to the emergency department without delay, Ladde says. "Shortness of breath, cardiac issues and stroke issues often start early in the morning. We know this based on human physiology. And a lot of patients think, 'I'm going to wait a while,'" and call the primary care physician in the morning. But this can be a dangerous proposition, he says. "If it's something that you think is potentially life threatening -- I understand, if it's 9 a.m. -- call your PCP and see if can they expedite things. But if it's 4 a.m., you probably ought to address it now. You don't want the patient getting sicker or even worse, so jump on top of your medical conditions instead of reacting to them" later when they may have gotten much worse. Particularly in heart attacks and strokes, time is of the essence, and delaying treatment can lead to worse outcomes.

[See: 14 Things You Didn't Know About Nurses.]

In addition to handling severe problems, Kupas says "the emergency department is good for things where you're not quite sure." He says he sees a lot of patients who think, "maybe it's just heartburn, but it turns out to be a heart attack," so if you're uncertain, it's usually best to err on the side of caution and visit the emergency department. The emergency department is also the place to go if you think you've broken a bone, as an urgent care center may be able to X-ray it, but if it's broken, you'll likely need to be referred to an emergency department for additional care.

But not every acute medical problem is an emergency, and Elliott points out that "some people overutilize the emergency room for things that are not a true emergency, such as medication refills [and] cold or flu symptoms." She says many people also seek emergency care if they lack a primary care physician, a phenomenon that also occurs in urgent care, all of which can drive up health care costs and soak up resources that should be going towards patients who actually need the emergency care. So when you're dealing with a health issue, take a moment and consider whether the problem at hand truly is an emergency. If in doubt, go to the ER. If it can wait, see your primary care doctor or visit an urgent care center.

Elaine K. Howley is a freelance Health reporter at U.S. News. An award-winning writer specializing in health, fitness, sports and history, her work has appeared in numerous print and online publications, including AARP.org, espnW, SWIMMER magazine and Atlas Obscura. She's also a world-record holding marathon swimmer with a passion for animals and beer. Contact her via her website: elainekhowley.com.