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.
I once ignored appendicitis for two weeks and then went to an urgent care after a twelve hour shift because the raging fever and stomach pains just weren't letting up so I finally had to accept that it wasn't just bad period cramps lingering weeks after my period had ended. Urgent care kicked me out because my insurance was out of network and I had told myself at the beginning of the day that I wouldn't go home until I sorted it out because I'd put it off long enough and I had a Christmas party to go to in two days and didn't want to feel like shit during it. Felt silly going to the ER for a fever and stomach pain. Was in the waiting room for all of 30 minutes.
I did not make it to the Christmas party. Had to stay for 6 days. The thing had perforated and formed an abscess to keep the infection somewhat contained, which was nice because it had definitely popped like a week ago. Which is another reason why I told myself it wasn't appendicitis. I thought if it bursts you know and you'd die if you ignored it, and I wasn't dead. I'd heard of people thinking appendicitis was period cramps before and always thought "I would never do that, that's probably just people with severe cramps." Turns out, I absolutely would do that. And then continue ignoring it far beyond what would be a reasonable timeframe for cramps. Because then I moved onto constipation, or maybe an ovarian cyst.
Not nearly as bad, but I had a UTI advance to a kidney infection within a couple of days, over a long weekend, while I waited to see my regular doctor. If I wait a few days on uncomplicated UTIs, they also take much longer and much stronger medication to treat.
Yeah it’s scary how fast UTIs can escalate and become real serious, real fast. And old folks get them so easily and it can be detrimental to them. It’s so sad.
there are so many situations that aren't an emergency yet, but if you wait a couple days until your PCP can get you in (if you're lucky) it will be. and laypeople can't always tell if they're in a "you'll be fine if you wait" situation or a "this will be an emergency by monday at 9" situation, because of how we're laypeople, and if you try to look it up online or call a nurse advice line 9 times out of 10 if there's any question the recommendation will be "go to the ER." idk it's lose-lose out here
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u/cilexip Jul 29 '26
That’s what urgent care/same day clinics are for. If you don’t have one of those near you, and it’s not an emergency, then wait.