San Diego Health: Urgent Care, Emergency Room or Walk-In Clinic?

(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 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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