(upbeat music)
- Hi, I'm Susan Taylor with Scripps Health
in San Diego, California.
You've got a sore throat, maybe ear pain,
a cough that won't go away or you're chopping up vegetables
for dinner and you cut your finger and it's bleeding
really badly, or your baby spikes a high fever
on the weekend.
Let's say you fell off your bike riding home at sunset
and you really twisted your ankle.
Or you're at home, and just before bed, all of a sudden
you get severe pain in your tummy.
Or maybe, you're short of breathe.
You're feeling dizzy, weak, numb, slurred speech.
What should you do?
Where should you go?
Urgent Care?
The emergency room?
Perhaps a walk in clinic?
Or should you be calling 911?
Knowing the difference between these places
to seek medical attention, could actually save your life
in a medical emergency.
Here to talk about this is Dr. Shawn Evans,
who is an emergency medicine doctor at
Scripps Memorial Hospital in La Jolla, California
and Dr. Siu Ming Geary who is
an internal medicine specialist and Vice President
of Primary Care for the Scripps Clinic Medical Group
in San Diego.
Thanks so much for joining us.
- Thank you. - Thank you, nice to be here.
- Let's talk about these different places to get care.
Let's start with urgent care.
What is the definition of urgent care?
- It's something where you have a disease or an illness
where you're not gonna have life or limb threatening
problems within a week.
So, somebody who may have matured an illness
or has an exacerbation of an illness that they have.
It might be after hours for example.
Or anything where someone doesn't feel imperiled.
Where they know they're gonna live more than 24 hours.
- So, and the difference between urgent care
and the emergency room.
- Emergency department is traditionally reserved for
people who feel they won't have 24 hours to live
or they have a limb threatening event.
So somebody who has had a sudden accident,
a sudden severe headache perhaps, they can't see,
ultimately fever, neck stiffness,
or they're unable to swallow, chest pain,
pain radiating to their back, sudden abdominal pain,
vaginal bleeding for example with abdominal pain
in pregnancy.
All represent emergencies as there can be life or limb
threatening injury or illness within 24 hours.
- And let's talk about these walk-in clinics.
What kind of symptoms would propel you to go to these
Scripps HealthExpress?
These are walk in clinics that are now open seven days
a week across San Diego County.
- So unlike urgent care and emergency rooms, walk in clinics
are really for low-acuity problems.
Things that you do want to be seen the same day for,
you don't want to wait, for example, cough, strep throat,
urinary tract infections, you can have abdominal pain,
rash, minor sprains, minor trauma, things that are not
serious enough to warrant a trip to the urgent care
or the emergency room, but your doctor may not have
an appointment for you that day.
That's exactly what I would use the walk in
clinics for.
- [Susan] And when do you call 911?
- I think what 911 should be reserved for people
who typically can't mobilize themselves.
They can't get up and walk on their own.
Someone who's dizzy, has chest pain.
Someone who's blood pressure may be disturbed.
Somebody who, for example, has been injured
and can't get up.
That's what traditionally, 911 is reserve, automobiles,
they shouldn't drive themselves, but if they have somebody,
a neighbor, or a family member who can get them
to the hospital, within 10 to 15 minutes, typically,
they're gonna do fine.
- I would also add that 911 is for when there are conditions
that should not wait to be treated.
So we think of heart attacks, we think of strokes,
we think of severe rapid bleeding.
In those cases, time really is critical
and if you call 911, the ambulance can take you
to the emergency room that much more quickly.
You don't have to deal with traffic.
You also have to reserve it also for those conditions.
- We'll come back and talk about this
in a couple of minutes,
but you just made me think of something.
Why are people reluctant to call 911?
Because you hear all of these crazy stories about
people driving themselves to the ER, when they're having
chest pains or they're dizzy.
Why they are reluctantto call 911 and drive themselves?
We'll come back to that in a just a couple of minutes.
Let's kind of go through, let's like laundry list
the symptoms, and then you tell me where you should go.
Whether you should go to a walk in clinic,
Scripps HealthExpress for example, or urgent care,
or ER, or call 911.
So let's go through them.
- Slurred speech?
- ER - That's emergency department.
- Emergency room, okay.
Serious burns?
- It's the emergency room. - Emergency room.
- Emergency room.
Chest pain?
- Emergency room. - Emergency room.
- That sounds like a heart attack, right?
What about a concussion, broken bones, a head or eye injury?
- Yeah, that's the emergency department.
- Emergency Room.
- [Susan] That is?
- Yeah, and the nice part for any of these Susan is that
if somebody goes to the urgent care, the physicians there
are gonna treat them perfectly appropriately
and get them to the emergency department
as soon as possible, if they need to.
- But let's say you've, you've fallen off your bike,
and you're bleeding, and you think you might have broken
something or you really twisted your ankle really badly?
Should you go to the ER or should you go to urgent care
for that?
- I think either would be suitable, yeah.
- And what about a head or an eye injury.
- (giggling) Well, when it comes to the eye,
I'd have to say, that's pretty important.
When you've hit the head, the issue is,
is does the urgent care, and all of the urgent cares
within Scripps can do CAT scanning, outside of that,
many urgent cares cannot.
They don't have advanced radiologic equipment.
If you're going to an urgent care, you may wanna
make sure that they have the ability
to actually take care of that particular illness.
- [Susan] What is a CAT Scan?
- A CAT scan is an imaging test that can be done,
where we can look at the brain and determine whether
there's swelling or bleeding after an injury.
- [Susan] Okay, and then Scripps ER's are located where?
- The emergency departments here are on Encinitas, La Jolla,
Midtown at Hillcrest and Chula Vista.
- [Susan] Okay, and then let's go through urgent care.
So, urgent care is non emergency care, right?
But it's really something that can't wait 'til tomorrow,
would you say?
- Things that can't wait are things that probably
shouldn't wait.
I think Susan, the important thing to remember
is that our emergency rooms are typically attached
to hospitals, so people who need surgery or rapid access
to specialists, trauma surgeons, et cetera.
An emergency room would have those.
Urgent cares, can be freestanding.
So they may have a lot of the ammenities that you need
to treat broken bones, and to diagnose,
fractures for example, they can give IV medications,
but they are not attached to hospitals.
So, they're kind of an in between.
An important thing to remember about our urgent cares
and similar to emergency rooms,
is that if you're not extremely sick,
you may have to wait because other patients
who come in who have more serious conditions,
or serious problems, will be seen before you.
- So, if somebody is coming in with symptoms
of a heart attack, they get treated right away.
- Correct.
- So for urgent care, let's do, fever without a rash?
- Correct.
- Dehydration?
- Perfect.
- Let's say you sprain your ankle.
- Yep.
- [Susan] Okay.
- Well, I would say if you can, if you can actually walk,
you could probably go to a HealthExpress Clinic.
Because for minor sprains, you can actually go
to a walk in clinic.
It may not need an x-ray, but if it's a serious injury,
that involves high impact, you fall from a heavy height,
you actually are in a moving vehicle and you get injured,
I would recommend an urgent care or an ER for that setting.
- I would agree and I'd say that if there is significant
swelling or bone deformity, that's probably time,
not just for urgent care, but to be considering
an emergency department.
- [Susan] What about wheezing or shortness of breath?
- Most wheezing, it would be dependent on the individual.
Healthy person wheezing and urgent care
would be perfectly fine.
- Somebody who's had chronic disease or pulmonary problems,
who's wheezing, probably should come
to the emergency department.
- There's a higher likelihood
of that person requiring hospitalization.
- [Susan] Okay.
What about dehydration, throwing up a lot, or diarrhea?
- I would say urgent care, for the vast majority
of people.
However if they have illnesses that take away their immune
system, they're on chemotherapy, if there in advanced age,
or if they suffered from other illness and have some complex
medical background, the emergency department is probably
the destination of choice given the likelihood of them
needing hospitalization.
- Okay, so the urgent care is located where
across the Scripps system?
- Torrey Pines, Vista, and Rancho Bernardo.
And all have advanced imaging.
- And then the walk in clinic.
What would you go to a walk in clinic for?
- Our Scripps HealthExpress clinics are ideal
for low-acuity problem, such as eye pain, eye redness,
allergies, ear pain, ear infections, strep throat,
bladder infections, skin rashes.
In fact, we even do sports physicals.
- So talk a little bit more about
the Scripps HealthExpress, because they're,
well let's talk about where they are first of all.
- So we have 12 locations throughout San Diego County.
There's Rancho Bernardo, Mission Valley, Carmel Valley,
Rancho San Diego.
There is Solana Beach, Vista, Hillcrest, I mentioned-
- [Susan] Encinitas.
- Encinitas, thank you.
- [Susan] East Lake.
- Yes, there's also East Lake.
- Okay, there you go.
I think you got 'em.
That's good.
There's a lot of 'em.
The bottom line is that there's Scripss HealthExpress's
all over the county from north to south.
And then, when are they open?
When are they open?
Because when you get sick, or you need medical attention,
it isn't during normal business hours.
- That's right.
- Correct.
And so this is the really exciting thing.
Our express clinics, they're open seven days a week,
Monday through Friday, 7 a.m. to 9 p.m.,
and Saturday and Sunday, 8 to 5 p.m., 8 a.m. to 5 p.m..
So, if you're doctor is not available or you'll have,
you can't go during work hours,
you can just pick up the phone, call us,
you can actually do a walk in, it's very easy.
- There's no appointment necessary right?
- Correct.
No appointment-
- You don't need to.
But you can also call Scripps HealthExpress to
make an appointment if you want?
- Well we don't call them appointments,
we reserve a place in line, because again,
this is a walk in clinic, but if you want us to hold
a place in line for you, you can actually go
on our website and do it electronically,
or call us, and we will actually put your name down
on the list.
- And you don't necessarily need to be a Scripps patient,
right, to have Scripps insurance,
to go to Scripss HealthExpress?
- Absolutely not.
We accept all patients with all different insurances,
and also on a cash basis.
So, anybody in San Diego can use our services.
- And then you also have pediatric clinics at two of
the sites.
- Yes, this is very exciting for us.
We have pediatric specific providers at two
of our locations.
Currently, that's Rancho Bernardo and Carmel Valley.
- And that's kids what?
What age?
- We see kids three months through 17 years of age.
- And they can, the hours there are?
- So currently the pediatric HealthExpress clinics
are available 5 p.m. through 9 p.m., Monday through Friday,
and 8 a.m. to 5 p.m., Saturday and Sunday.
- And the Scripps HealthExpress, this walk in clinic,
this does not replace your primary care physician, correct?
- No, and we weren't meant to do so.
This was really to supplement our offerings for our patients
and for our regular, for all of San Diego.
So, primary care, we recommend that you see a primary care
doctor for your health physicals, for chronic disease,
for anything that requires more than one visit.
So, really all your primary care doctor can see you for
your cough, and your cold, and the bladder infections
that I mentioned.
Sometimes, they're closed when you actually need
to see them, or sometimes they may not have an opening
until two days from now, so this is an additional resource,
that we're offering to our patients.
- And if you're in doubt about where to go,
what should you do?
Between walk in clinic, urgent care, ER.
- So we have a nurse phone line that you can actually call
for HealthExpress.
If you're not sure, you can always call and our nurse
will actually ask you questions, and based on your symptoms,
and your medical history, give you advice on where to go.
If you're not sure, and it's something, you think
is serious, I recommend you call 911.
Better safe than sorry.
But if you go to any of our clinics,
if you go to HealthExpress clinic, and they evaluate you,
if you need to be sent to an emergency room
or sent to an urgent care, they will let you know
at that clinic, at that time.
- Dr. Evans, what about you?
If somebody's unsure where to go whether
it's the urgent care, or the ER, what should they do?
- I always tell 'em that if they really feel that this
is the last day that they're going to have or if they
have questions about an illness that they know is serious,
or they felt a rapid change in their condition,
that's the emergency department.
After that, most folks will do perfectly well calling the
nurse hotline, calling their primary care physician,
and we're always available to take questions.
And the nice part, I love in the Scripps Health System is,
is that regardless of the venue that you choose,
your primary care doctor is gonna have that information the
first thing that they arrive in the next morning.
- Alright, so we referenced this a couple of minutes ago,
let's come back to this.
Why are people reluctant to call 911?
You hear all these stories about folks feeling short
of breath, chest pain, and then they get in the car,
and they drive themselves to the ER.
- Very hard to acknowledge that you need help.
And for all of us, nobody wants, lights, and sirens,
and firemen, and folks in big, heavy yellow gear walking
up to the house and knocking on the door,
and to be surrendered to help.
When they arrive in the Emergency Department,
that's probably one of the most sensitive things we see.
Is that folks come in, and this is the first time
in their life they've really needed help
that they felt imperiled,
so 911 is an absolutely wonderful and fundamental element
of our society and of our critical recess team.
When to call is important and I would say that if
somebody feels their gonna lose consciousness,
if they can't mobilize themselves, if they don't have
access to transportation.
If they have any of the big three, if their head,
their vision, their breathing or their chest for example,
or their abdomen feels imperiled or severely injured,
they need to get to the emergency department.
And it's 911 every time.
Strokes and chest pain are the two most popular sources
of source of complaints where people
will take 911 appropriately.
So, if somebody's dizzy, or has slurred speech,
or trouble with their vision, or difficulty mobilizing
themselves or chest pain of any sort, that really is 911.
So that those access providers can get you there in traffic,
out of traffic, and you're with somebody who can responsibly
take care of you more important, when you're on your way.
- I would add to that.
I think that sometimes patients are scared that maybe
what they have is not a true emergency and they don't want
to waste people's time.
I also think that sometimes people think, is this going
to be covered by my insurance?
Is this going to take a long time?
There are many reasons that I think people are reluctant
call 911.
But it is scary.
Am I sick enough to warrant a whole team of emergency
personnel to come to my aid?
- Yeah, I would really platform on that.
That's one of the first things that people will say,
is this, was this appropriate?
They don't know, but I can tell you it's appropriate,
and if they were that concerned, they're protected,
they're understood and they're gonna received in a warm
environment where we know that you had no other opportunity
but to call 911.
- Correct, I agree.
Better safe than sorry.
- Absolutely.
- So err on the side of caution?
- Please. - Correct.
- Okay, what, how should you be prepared when you go
to any one of these places?
What should you bring with you?
If you're gonna go to an urgent care, well or the ER,
or the walk in clinic.
- I think know that the person taking care of you,
whether it's the nurse or the doctor, or anybody else,
they want to know your medical history in order
to treat you appropriately and then give you
the best care possible.
They need to know what allergies you have,
what medications are you currently taking,
what medical problems have you had, do you currently have,
have you had any prior surgeries.
All of these actually make a difference when a provider
who can, who's assessing you wants to quickly and accurately
diagnose you and treat your condition, whatever that is.
- I would agree and as accurate
as our health care record is, there's always a little
disparity because of recent events where somebody
might be on a different medication or they are traveling.
Please keep a list of your medications
include your allergies.
And there's one more thing, provide a phone number
of somebody we can reach out to who can give reasonable
information in the event that you become unconscious.
Or alternatively, somebody who knows you and can help you
to make decisions, if things are dire.
- Okay.
What about letting somebody know if you're allergic to
anesthesia?
- Always important.
Always important.
That allergy profile and the significance of that allergy.
Many times, we'll see lengthy allergy profiles,
but none of them are significant.
What we wanna know is, is anything that we're gonna give you
in a life threatening crisis gonna contribute to harm?
That's what we need to know.
- Okay, and you said bring a list of medications,
would that include supplements as well?
Or just prescription drugs.
- Absolutely, supplements can also cause interactions
with other medications.
And also, some people are sensitive or intolerant of
ingredients in the supplements that might be in the
medications we prescribe.
- Again, I would just emphasize for a moment,
that anyone traveling, if they've had any health issues,
if they've had to previously us 911,
if they take medications, it really is reasonable
to sit down, and list their medical issues, their surgeries,
whom we can call, their medications and the allergies.
Those five things alone, give us an enormous leg up
in the event that somebody from out of town,
we can't access their information in a timely manner.
It really does, help and it also lends to the accuracy
of us taking care of them.
- And time is really critical when things are--
- Absolutely.
It's a big deal. - An emergency situation.
- And even in a non emergency situation.
The more information you can give us up front,
the faster we can see you and have you on your way.
- So the bottom line, trust your gut?
(laughing)
- Unless your gut is sore.
(laughing)
- Any final thoughts?
- Yeah, I would say that people's respect for the 91 system,
911 system is appreciated, but that if you feel you need
to use it, please do so.
That system is in place to get you to the hospital
in a time when you're in crisis or you're not sure
what to do with your family member.
The one thing we do see is with both strokes and heart
attacks, people will oftentimes go to bed,
with their symptoms.
We've all gotten better going to sleep and feeling better
the next day.
If you're someone who's at home and it's the evening hours,
and you're not feeling quite right, it's probably not best
to go to bed.
It's probably best to at least get some nurse advise
over the phone or at least engage a family member,
and consider getting to the hospital that night
as opposed to waking up with much more significant symptoms.
- So, and I would like to add that for HealthExpress
clinics, it's a wonderful resource
because we mentioned earlier, if you're very sick,
and you go to the ER urgent care, you're seen first.
Which means, if you have a cough, or you're,
a bladder infection, or a rash, or anything else
that's considered less serious, you will be put
at the back of the line, you will have to wait
a little longer while we deal
with these life threatening conditions.
So the HealthExpress clinics are wonderful in that
because you walk in, you'll be seen much more quickly,
you won't have to wait, sometimes hours, depending on
how busy and which place you're going to.
And some of these conditions,
because you're seen more quickly, we have patients,
who because they don't want to go to urgent care and wait,
or go to the ER and wait.
This is actually a place where you can get care
and not delay treatment for issues
that shouldn't be delayed.
- Alright, that's strep throat.
- [Dr. Geary] Correct. - [Dr. Evans] Yeah.
- That nasty throat or that nasty earache.
- Or the bladder infection that can, if untreated,
turn into a kidney infection.
- My family and neighbors love the HealthExpress System
and the physicians and staff are fantastic.
And their ability to refer and their ability to get you
where you need to be should something need to get escalated
is absolutely wonderful.
- Thank you both very much.
- [Dr. Evans] Thank you Susan.
- Scripps is repeatedly ranked by U.S. News and World Report
as among the top healthcare systems in the nation.
If you'd like more information on where to go,
urgent care versus the ER, or Scripps HealthExpress,
the walk in clinic, and when to call 911,
please just click on the link or go to Scripps.org/videos.
If you want more critical information about your health,
we take care of you from head to toe.
Please subscribe to our Scripps Health Youtube channel
and also follow us on social media @ScrippsHealth.
I'm Susan Taylor, thanks so much for joining us.
It's our mission at Scripps to help you heal, enhance,
even save your life.
(upbeat music)
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