Rob got a cat bite. Then a swollen hand. He goes to the ER, gets antibiotics, then develops itching. So he calls me for advice.
A few days later, I get this e-mail: “The itching from the antibiotics went away as you said it would. But what is NOT poised to go away is the $624 bill from the ER for talking to a doctor for 5 minutes. No blood drawn, no stitches made, no X-rays, but I’m told the standard amount for the classification of my visit is $624. I called to complain and, of course, the person on the phone can’t do anything. Well, she could have sounded sympathetic. I didn’t even know that there’s a difference between an urgent care and an emergency room. Apparently, an urgent care would have been cheaper. Where is there an urgent care downtown?”
Urgent care is just 2 blocks from the ER. But why didn’t Rob just call me? He wasn’t sure. Why do so many patients like Rob end up in the emergency room with non-emergent conditions? Let’s think this through.
An emergency is a serious, unexpected, and often dangerous medical condition requiring immediate action such as a heart attack or gunshot wound. An urgent medical condition is a very important, but non-life-threatening situation that needs immediate attention such as a dislocated shoulder or kidney infection. A routine medical condition is neither urgent nor emergent such as high cholesterol or hemorrhoids.
Let’s say I’m your family doctor. It’s Saturday morning and your kitty bites you. Your hand is suddenly red, hot, and swollen.
Should you go to our 60-room, 44-bed, 30,000-square-foot emergency department and trauma center that includes a waiting area with a fireplace and a children’s playroom? Do you really need 2 psychiatric holding rooms, 2 trauma suites, and a decontamination room with a dedicated entrance for patients exposed to hazardous material? Upon arrival you may be treated by up to 4 doctors and 17 nurses, all emergency-trained and you’ll have 24-hour access to anesthesiologists, neurosurgeons, and all manner of specialists. In case you need to arrive by helicopter from the 8-county service area, expect to enter an extra wide mega-elevator that will enable your continuous care during transport from the hospital’s rooftop helipad. By the way, if you need this level of care, please call 911.
Or should you go to our 6-room, 3,000-square-foot urgent care that staffs one family doctor, a nurse, and a medical assistant? They do X-rays and labs and they’re open from 9:00 am until 9:00 pm every day with six locations in town.
Or should you call me? I work in a cozy 280-square-foot clinic. I have no staff. I handle urgent and routine conditions and perform minor surgeries. Once, I even removed metastatic lung cancer from a guy in my office. I work most afternoons, but I’m available 24/7 for urgent needs. Best part: my low overhead allows me to pass savings on to you. How can I do this? Watch my TEDx Talk.
Today Rob sends another e-mail: “In addition to my initial fee of $624 associated with my cat bite, I got a second bill for $194.70. It’s totally different looking and is from the Emergency Physicians. The bill references a nurse practitioner. I suppose I never actually saw a physician.”
The truth is: you could get treatment anywhere for your cat bite. The real question is: how much do you want to pay for it?
Emergency room: $818.70.
Urgent care: $99.
My office: $50.
Pamela Wible, M.D., is a family doc in Eugene, Oregon. She is author of Pet Goats & Pap Smears. Photo by Geve.