Transcription:

Melanie Cole (Host): The discussion of whether to go an emergency room or urgent care or visit your primary care provider is really a tough one for patients, especially for parents. In this panel discussion today, my guests are Dr. Luis Ticona. He’s a general internal medicine physician and Mercedes Diaz. She’s a nurse in primary care and they’re both at Boston Medical Center. Thank you so much for being with us today. Dr. Ticona, I’d like to start with you. What’s the difference between primary care visits, urgent care and the emergency room?

Luis Ticona MD, MPH (Guest): That’s a very good question and a lot of my patients I think just don’t quite understand the difference. I would say very simplistically the emergency room is a place for kind of life or death emergencies. It’s best suited and actually created to triage people into urgent surgeries and urgent inpatient hospitalizations and not so much for kind of less acute or more minor complaints like sore throats and back pains. So I would say the emergency room is best suited for that.

I think the difference between an urgent care and a primary care office, the biggest one I think is the ability for you to walk in to an urgent care facility. So, they have kind of open access. People can walk in and it’s really designed for more minor complaints. Think your sore throats, back pains, complaints that could be dealt with in the primary care office but often they are not designed to just accept walk in patients. Although, I would say kind of to close out the primary care part; I think we all recognize how important having access to your doctors is for our patients so, many practices kind of around the country, are really thinking about how we accommodate these visits on a same day or next day basis. So, primary care, that’s what we do kind of every day, we think about how to help people that have these more minor complaints like belly pain, back pain, sore throats, knee pain, minor scrapes, minor burns, these kind of what feel to our patients like very urgent questions. Often our nurses can help think about what best to do at home and or they can help offer an appointment either the same day or the next day.

Host: Dr. Ticona, sticking with you for just a second. When people are trying to make that decision, and we’re going to talk about some different conditions so that you guys can clear it up for us. But what about testings, scans? If someone has belly pain and they call or their child has belly pain and they call their primary care provider; would you say come in here, let’s look at it or go to urgent care because they can do an x-ray, or they can send you for tests. What kind of testing and scans can somebody get at urgent care?

Dr. Ticona: So, I think there’s an availability for all types of urgent scans but maybe taking a little bit of a step back; I think this highlights how difficult it is for our patients sometimes to wrap their minds around how best to access scans and this level of care. So, I often tell my patients just call us. Call your primary care doctor’s office. We all have nurses that can help you make that decision and actually often they will be able to look at your chart and understand what other comorbidities you may have or other diseases you may have that could help you make the decision of whether to go to an urgent care or a primary care office or even the ED. But I would say, we all have access to the same kind of testing. It’s more about how quickly it will kind of turn around. It will be reviewed by radiologists but I for example, can order a CAT scan that can be done later tonight if I need to. But i think thinking about when you go to the ED, it’s more along the lines of needing to do a scan that has a review within an hour.

Host: What a good point. So, Mercedes, how can a nurse help us figure out where to go or give us advice? As Dr. Ticona said, you have access to our charts which is a huge plus. What happens? What does it look like when a parent or a patient calls you and says what do I do, where do I go?

Mercedes Diaz RN (Guest): Right, exactly. We do have access to their charts which is great. What I do if a patient calls for a certain complaint, I open up their chart, kind of review the last time they had been seen, what other comorbidities they do have. Then I give them a call, see what’s going on and do an assessment from there over the phone to help figure out the best – to determine what type of care is needed, whether that be to come in to see us for an appointment either today or the next day or like Dr. Ticona did mention, going to an urgent care clinic which does offer the same type of services that we do. It’s just based on whether the patient could come in today or the next day if it wasn’t available for them, if that didn’t work with their time schedule. Or to see if the emergency room was actually needed.

But we have access to their chart, and it makes it ten times easier just to determine kind of work with something so we know how to best care for the patient and let them know what the next step would be.

Host: That’s great advice Mercedes. So, tell us when people call you, what kinds of complaints? Dr. Ticona mentioned a few. But Mercedes, tell us what we’re talking about here before we talk about the emergent conditions. What kinds of things would you want patients to call you about? Is diarrhea or vomiting something you go to the emergency room for or is it something you call your primary care provider for? Tell us what you would like people to call you about.

Mercedes: Sure. I would love patients to call me if they are having symptoms regarding urination, if they are having any painful urination. Any questions about pregnancy, if they are concerned about that. Colds, symptoms of colds; a sore throat, coughing, symptoms along those lines but honestly, I would love patients to call me for anything and sometimes it’s difficult for patients to realize they actually may not realize the severity of their symptoms and that’s okay, that’s what we’re here for and it’s not a bother to us. It’s always best just to call us. There are at least two to four nurses that are on the floor that can call you back within two hours or even less than that. And we can figure out what your symptoms are and determine what’s best from there.

Things like you had mentioned diarrhea, nausea, vomiting. That’s something that does depend, and we would need to talk to the patient to see if there’s more symptoms other than just the diarrhea or the nausea or the vomiting to figure out what route would be best.

Dr. Ticona: Alone the same lines, I definitely think what Mercedes shared is the right advice. We welcome our patients to call us with anything because I think it depends almost patient to patient the type of advice that we would be able to share and the self-management advice. So, I think the broad message would be just call us. We have nursing and they can do pretty incredible things in terms of recommending management advice at home or even which I think is really important, alerting us the primary care physicians that the call occurred and get out opinion on what the best approach would be after that call.

So, rather than – now there are certain conditions like severe chest pain, or people feeling like they are going to faint right away; those are conditions that are truly emergencies and I think most folks understand that. But if there is a question as to do I go, or do I not go to the emergency room; I think people should definitely fall into calling us first to kind of help by advice. And in fact, a lot of our lines are manned 24 hours seven days a week so you can call literally at three in the morning and often have the opportunity to talk to an actual doctor that can help you make some decisions.

Mercedes: Right and to touch base on Dr. Ticona’s comment. The nurses, we are working with your doctors. We are working with the patient’s doctors and we have access to either page them if they are not working that exact day and we can get answers right away if we are not exactly sure what to do either. So, we definitely can provide answers right away to the patient to let them know what the next step would be, which visit type would be the best.

Host: Well I’m certainly glad that you both went over that because people do not always know and if it’s abdominal pain, right away our minds go to appendicitis, running into the emergency room. So, Dr. Ticona, first last word to you. What would you like the listeners to know about Boston Medical Center’s Primary Care providers and staff and educating patients about this and about the clinics and how they make that tough decision.

Dr. Ticona: I would say, I would underscore that we’re here to provide advice. And folks I think kind of recognize, have an intuition around true emergencies. Like I said, things like chest pain, things like feeling like they are going to faint; those can sometimes mean more acute things. So, they should be triaged – the patient should feel comfortable kind of maybe going to the ED. But for just about everything else, they really should give us a call because like I said, we have access to their chart, we can give them some advice over the phone, and we can actually bring them in to our office to assess them more carefully if we feel like it’s needed. I’m always surprised by folks telling me, like oh I was thinking about going to the Ed and they come to see me in the office and I kind of say like well I think this is just a viral sore throat. And we need a little bit of time and you need to keep hydrated at home and I worry that they could have gone to an ED, sat there for six, seven, eight hours waiting for somebody to assess them when we were able to take care of it in a much more friendly fashion. So, definitely call us first and we love to kind of help our patients make those right decisions.

Host: I think that’s a great point Dr. Ticona and the fact is that anytime we can reduce patient emergency department visits for things that would qualify as low acuity it’s going to save money and healthcare costs all around for the patient and for the healthcare facility. Mercedes, last word to you, what you would like listeners to know about you, your nurses, your staff; the importance of you guys as the support system for the primary care providers like Dr. Ticona and what you would like them to know about calling you when they have any questions.

Mercedes: Right. I would definitely – like I said earlier, the nurses are here to help. Don’t ever feel that you’re calling us and it’s going to be a bother or we’re too busy. This is our job. We want to help you. We want to give you advice. We have other nurses to help support us as well if we ever had any questions. If you aren’t sure on what to do, on whether or not to come in to see us or if you should go to the emergency room or if you should be going to an urgent care clinic near your home. Give us a call.

I know patients sometimes call and say oh I Googled this and it’s telling me this and I know online is very tempting but it’s better to talk to a nurse so that we can help you from improperly self-diagnosing and just to ensure that you get the right treatment and the right care, and you get it at the right location. And sometimes I’ve spoken with a lot of patients who actually thought they needed a visit to come and see us but really, I provided them some medical advice over the phone, and I tell them give us a call back in a couple of days. I make a note to myself if I don’t hear back from the patient, I my advice doesn’t work, give us a call. And most of the time, I don’t hear from them or if I do reach back out to them, everything is better.

And that makes me feel much better that we avoided a trip to the emergency room and not that we don’t want to see you in clinic; but just not a hassle for you to have to come all the way down to see us as well.

Host: Absolutely great advice and so important for listeners to hear. Thank you both for joining us today. And that wraps up this episode of Boston MedTalks with Boston Medical Center. Head on over to our website at www.bmc.org/primarycareaccess for more information and to get connected with one of our providers.

If you found this podcast as informative as I did, please share with your friends and family so that we can all help each other and learn from the experts together. And don’t miss all the other interesting podcasts in the Boston Medical Center library. Until next time, I’m Melanie Cole.