When to (and when not to) go to the ER

August 30, 2011

Mark L. Friedman, MD, FACEP, FACP

According to the American College of Emergency Physicians, warning signs of a medical emergency include: difficulty breathing, chest or abdominal pain, fainting, weakness, dizziness, changes in vision, confusion, difficulty speaking, severe pain, uncontrolled bleeding, severe vomiting or diarrhea, coughing or vomiting blood, or suicidal feelings.


If you're not sure when to go to the ER, use common sense, but err on the side of caution. Better to go if you are not sure. If symptoms are severe or getting worse, call 911 to get an ambulance.

If you are having a less acute problem, consider more cost effective and convenient alternatives. Your primary care physician may see you on a walk-in basis, or you may have to schedule an appointment. Urgent care centers have extended hours and see walk-ins.

Another option is to consult a telemedicine physician, which has been found to significantly improve survival, according to the New York Times. A physician call can often help you make the decision as to whether to go to the ER or arrange for an alternative. In simple cases they can even phone a prescription in to your local pharmacy.

Yet another high-tech option is a computerized triage system. The best of these can help you make the decision as to whether you need emergent or urgent care, or whether you can wait to see a doctor.

If you do need to go to the ER, cost considerations should not stop you. Understand, however, that there will be a cost--to you, your insurer, or both. Make sure you understand your coverage. Don't be afraid to call the insurer and ask. If you are paying out-of-pocket, don't hesitate to ask about the necessity of (often expensive) tests and treatments. You are not obligated to agree with everything the doctor recommends, but make sure you understand the potential consequences if you refuse what he suggests.

Afterwards, carefully review the bill. Has your insurance paid its share? Is the bill accurate? If you are uninsured, will the hospital accept a discounted fee? Do you qualify for (low-income based) "free" care? Consider a patient advocate to help.

Look through the information on our website, FirstStopHealth.com to understand your health care options before they become an emergency.

Originally published Aug 30, 2011 11:31:35 AM.