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What is the difference between an urgent-care center and the emergency room?

Dear Dr. Lanny: What is the difference between an urgent-care center and the emergency room? And how do I know when to go to which?

A: Picture two scenarios. No. 1: It’s 8 p.m. when little Mary, age 3 (not her real name, as nobody names their daughter Mary anymore) complains that her ear hurts. She feels warm to touch, but you can’t find the thermometer. You offer her acetaminophen--generic, of course--and put her to bed. Four hours later she awakens, whining, in modest pain, and distinctly warmer than when put to bed.

No. 2: Little Lance, age 5, has been riding his bicycle around the driveway when his pants get caught in the chain. He does a header over the handlebars and lands on his outstretched arm. He gets up screaming and his forearm now looks distinctly bent out of shape. He has dirt on his face, but his head is fine as he was wisely wearing his bicycle helmet.

There is little doubt to any parent that Lance has a significant injury, and that he is in acute discomfort. Most parents would easily recognize that this is a problem beyond the scope of their pediatrician, and that this needs immediate attention. Clearly this is a reasonable case to take to an emergency room.

The first scenario, however is a lot less urgent. Mary is uncomfortable and feverish but clearly in no acute distress. It is also four hours since she had pain and fever medicine. It would be quite reasonable to give her another dose of acetaminophen, put some warmth to her ear, tuck her back in bed, and see your doctor in the morning. 

But you’re worried and remember a prior episode when Mary’s ear started to drain a foul yellow pus. In this case, there is a sick child but no acute danger or distress. Your concerns are pain and possible complications. Being seen is reasonable, but this is not an emergency and, if available, a prompt or urgent-care center makes sense.

Why is this a big deal? Emergency services are precious and should be immediately available for those who are truly undergoing an emergency. Emergency rooms filled with non-emergency patients may have to turn away the truly sick or injured or delay getting them care. 

Second is the question of cost. Given a choice, your own doctor is where to go. If she is unavailable, go to the lowest level of care needed.

One local hospital’s prompt-care center charges approximately $100 to get in the door. This is exclusive of doctors’ fees and any lab work. The same hospital costs twice that price to get in the emergency door.

And even if your private insurance or Medicaid covers the cost, we all pay in some way. Your insurer will raise everyone’s premium to guarantee their profit, and our taxes will increase or the services decrease to pay for Medicaid. Nothing is free.

Our medical system is frighteningly expensive, and we are no healthier than other industrialized nations that spend much less. We all play a part, doctor and patient alike, in the dollars that are spent and should act as responsibly as we are able.         

© Family Times: The Parenting Guide of Central New York