Recently, on a four-day weekend, we were lucky enough to head down to the Florida Keys for a little rest and relaxation. After arriving late at night we planned our next day’s events which included plenty of water activities and sunshine. Unfortunately, I woke up with left-sided facial swelling accompanied by severe pain and numbness. I often over analyze a medical situation since I am a registered nurse and many times I fear the worst; I also know facial numbness is a possible symptom of a stroke so I chose the emergency room for a proper diagnosis. For one thing, there were no urgent care or walk-in clinics on this particular key so that was really my only choice.

Luckily it was only a parotid stone [a stone usually made of excess minerals in the salivary gland] which “just kind of happens to people like forming a kidney stone”. The treatment was fairly simple. Drink copious amounts of water, suck on sugar-free lemon drops and apply ice packs until it resolves. The physician also considered antibiotics since it could have also been a tooth abscess. I decided to hold onto the antibiotics until I visited my dentist who also felt it was a parotid stone. After 24 hours my face was back to normal so I guess I did pass the stone but I do wish I at least had the opportunity to visit an urgent care center. Between the wait time I experienced and the final whopping bill, I understand why there are so many urgent care centers popping up!

Having diabetes, especially if uncontrolled, may present some unexpected medical issues directly related to diabetes or a completely unrelated medical problem. When diabetes is uncontrolled white blood cells do not function as they should which sets you up for a higher rate of infections. It could be a critical decision deciding where to go for your emergency issue. Let’s look at some of the differences between an E.R., an urgent care center, and a walk in-clinic.

According to Shawn Evans, an emergency room physician at Scripps Memorial Hospital in La Jolla, California, recognizing the difference between ’emergency’ and ‘urgent’ can be confusing since they both indicate a medical need that should be addressed quickly. The distinct differences include the level of care at each facility”.

Urgent Care Centers

Urgent care centers started to evolve in the 1990s and have recently flourished. They generally treat non-life threatening conditions, have lab testing, offer in-house blood work with immediate results and may even provide imaging services. Most facilities provide simple x-rays, bone densitometry and ultrasound. Some even offer mammography and the capacity to perform MRIs and CAT scans similar to a full service hospital. An urgent care center is an excellent place to visit if your regular physician is not available because you suddenly become ill or suffer from an injury during the evening, night or weekend. An urgent care center allows you to walk in without a scheduled appointment and takes you in the order you sign in. They usually operate from 9AM -9PM –Monday through Friday, 9AM-6PM on Saturday and 9AM-5PM on Sunday. You should be aware of the center’s hours near you and post them on a bulletin board or in your phone. There are certain appropriate times to go to an urgent care center over an emergency room instead of just trying to treat your issue at home. Included would be non-life threatening problems such as pink eye, dehydration, seasonal allergies, insect bites, urinary tract infections, vomiting, ear pain, acute diarrhea, minor athletic injuries, sprains and strains, superficial cuts, splinters, sore throat, cough, sinus problems, skin rashes without a fever and congestion or flu- like symptoms.

It is generally better to contact your primary care doctor or endocrinologist when you have reoccurring chronic infections such as yeast, skin fungus or UTIs from out of control blood sugars. They have your complete medical history and know which treatment has worked for you in the past. The cost of an urgent care center usually runs between $50-150 per visit. It depends if you are paying through insurance and what your co-payment is. If you do not have health insurance you will be charged extra for x-rays, lab and blood work but it still will be less expensive compared to the E.R. Many urgent care centers are now offered through specific hospitals so if you are familiar or comfortable with the hospital’s reputation then that may be a good fit. Other urgent care centers are privately owned or are affiliated with chains including MD-Now. According to Holy Cross Hospital in south Florida, “the majority of people who go to the E.R. don’t really have true medical emergencies and may pay up to 6 times the cost compared to an urgent care center”. The wait time will generally be longer in an E.R. as well when you are not critically ill. Not only will a good decision save you money but it will save the health care system money as well which will hopefully come back to you in the end through lower insurance rates.

Walk-In Clinics or Minute Clinics

Walk in clinics or minute clinics are usually available in pharmacy chains, grocery stores or retail chains and big box stores. They are generally staffed by nurse practitioners or physician assistants who will not have all the resources offered by an urgent care center or hospital E.R. Walk in clinics are especially good for school/camp/sport/work physicals, flu/pneumonia/shingle shots, colds, sore throats, coughs, ear aches, stomach bugs or simple sprains. They will be able to prescribe what is available in the pharmacy whether needing a prescription or for OTC products and the cost will be more reasonable. Health insurance usually pays for vaccines.

A True Medical Emergency.

Most people can often sense a true medical emergency just from an instinct but never try to second guess what you actually need. If you are not sure ask for help from a significant other, family member, friend or co-worker. They may be aware of symptoms that you are not.

When to Call 911

Many people feel unsure or uncomfortable calling 911 because they do not think they are sick enough. This could cause a serious risk. When experiencing chest pain, chest tightness, jaw pain, profuse sweating, indigestion, nausea, or arm pain, think about the possibility of a myocardial infarction or heart attack and call 911. If you have severe bleeding or burns, call 911. If you experience the symptoms of a possible stroke such as sudden confusion, visual disturbances, sudden weakness, loss of vision, slurred speech or one-sided facial numbness and weakness, call 911. The paramedics will start performing life saving measures in the ambulance ride which may literally save your life. No one will ever condemn you if you end up with gastric reflux instead of a heart attack, but you will be the one who suffers if you guess wrong.

Emergency Rooms

Emergency rooms are open 24 hours a day and 365 days a year and are staffed with ER physicians and nurses who specialize in true emergencies. They are prepared for the most complicated emergencies with access to all specialists as well as medical equipment. They are contained within the actual hospital. If choosing to go to the emergency room, it should be utilized for a true medical emergency. Included would be chest pain and tightness, seizures, accidents with trauma, changes in mental states, changes in balance, sudden numbness, weakness or paralysis, speech slurring, a compound fracture where a bone is protruding through the skin, visual changes or disturbances, a racing heart with palpitations, an irregular heart beat, eye injuries, knife wounds, gunshot wounds, severe burns, severe hypoglycemia with unconsciousness, diabetic coma, head injuries, severe headaches or severe bleeding that requires surgery and stitches. These medical conditions will require further testing, monitoring and more intensive care. The cost of an E.R. visit can start at around $650 and go up to thousands of dollars. When experiencing a life threatening problem, finances should not be the priority. The E.R. will triage you or put patients in the order of the most serious symptoms, not in the order you arrived. Hospital ERs will work with you on most bills and always feel free to check and discuss your bill for details even if insurance is responsible.

Please consider these recommendations as “guidelines” and in no way make them your final decision in which facility you should go to for your medical conditions. You must make the best decision based on your individual needs. Neither an E.R., walk-in clinic or urgent care center should be your first choice to treat chronic illness including diabetes, heart disease or hypertension. Your primary care doctor, endocrinologist or cardiologist should be following you every 3-4 months with routine blood work and a physical exam. They have your complete history and are most familiar with your personal needs and problems. People with diabetes are at a higher risk for possible complications including a heart attack or stroke and that is when the option would be the emergency room. Be your own best advocate and know all your available options!

Have a question? Comment below or email me at RKleinman@adwdiabetes.com if you would like to share them with ADW diabetes.


NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.

Roberta Kleinman

Roberta Kleinman

Roberta Kleinman, RN, M. Ed., CDE, is a registered nurse and certified diabetes educator. She grew up in Long Island, NY. Her nursing training was done at the University of Vermont where she received a B.S. R.N. Robbie obtained her Master of Education degree, with a specialty in exercise physiology, from Georgia State University in Atlanta, Georgia.

She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.

She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.
Roberta Kleinman

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