Conway McLean, DPM, Journal columnist

Joe was sick and tired, of being sick. The sneezing developed first but was followed quickly by various symptoms, most of them centered around his respiratory system. The body ache occurred a day or two later but was relieved with Tylenol. He was able to survive the last day of his work week, greatly appreciative of the arrival of the weekend. But he started to worry when his fever spiked to almost a hundred and one by Saturday evening.

And then the most telling event, he vomited. What if he had something serious, like COVID? His worries became fueled by his imagination; something needed to be done.

Joe knew well his primary care physician had no weekend hours so a trip to the emergency department seemed the best bet. But was this his best and most appropriate course of action? A survey on the topic might produce varied responses but knowledgeable individuals would resoundingly say no.

Emergency room visits are frequently made for problems that aren’t truly “emergent.” This is a common situation in American health care with nearly a third of all emergency department visits for a problem best treated elsewhere. Too many go to the ER for non-urgent conditions.

The reason an individual presents for emergent care is a topic of conversation by health policy experts. What problems should be considered for such care, requiring specialized facilities and services. One study found the visits judged to be non-urgent equaled 37 percent of all emergency department visits. What kind of conditions should not be brought to the emergency department? The definition says a problem for which a delay of several hours would not increase the likelihood of an adverse outcome.

How to curtail inappropriate use of the ER has been a challenging question. What demographic is primarily responsible for these visits? Some studies have noted that younger adults were more likely to have non-urgent visits.

Various articles have assumed that less urgent complaints have been seen more often in late evening hours and on weekends when clinics aren’t open. Yet roughly 34% of ER visits were during typical business hours.

Likely an important factor in this discussion is the convenience of the emergency department compared to alternatives. Simply walk in the door and someone will see you.

Also a common reason is a referral to the ER by some health care provider. Another factor is the negative perceptions people can have about their primary care physician.

Some have hypothesized that overuse of the ER was related to insurance status or maybe the type of plan the patient had. If that were so, then increasing access to primary care would decrease the incidence of such ER visits.

Yet one study demonstrated that insurance status and lack of a primary care physician had little effect on the utilization of the emergency room.

Financially, crowding of the emergency department has consequences. An ER visit is generally not as cost effective as a primary care visit. This misuse leads to excessive spending, unnecessary testing, unneeded treatment, and poorer relationships with their health care. In addition, studies have demonstrated emergency department overcrowding and overuse means staff are often unable to follow recommended treatments and protocols.

Obviously, there is a time to go to the emergency room. Some good reasons include shortness of breath, chest pain, or pain in the left arm. Any serious burn or any kind of seizure are both good ones. An allergic reaction causing difficulty breathing or swelling of the lips. Any symptoms associated with a stroke like slurred speech, or weakness of some body part, all warrant a trip to the emergency department.

Some good advice when considering any condition possibly leading to use of the ER starts with doing what your mom used to tell you to do: rest, drink plenty of fluids, take over-the-counter medications. But if you are systemically sick, meaning your illness affects your whole body, and you have a severe, sudden onset of pain, calling for emergency medical services may be the prudent course. If you have the immediate development of paralysis or you pass out (but not because you stood up suddenly), again, dialing 911 can be lifesaving.

If you aren’t getting better with time, or symptoms are worsening, and you believe you need to see a doctor, call your primary care provider first. Some primary care physicians are even able to provide virtual visits, assessing patients for many different problems. Urgent care facilities generally have long and convenient hours, often being equipped with radiology and lab services.

Joe didn’t go to the ER. He took some Tylenol and went to bed. (Naturally, he felt better in the morning.) But overuse of the ER will increase according to most predictions, a result of increasing demand and a shortage of primary care providers. Understandably, there is great interest by all parties involved in successful interventions which will discourage overuse of our emergency rooms. No easy answers have been discovered, but you can do your part. Avoid a long wait in the ER waiting room, especially if you don’t need that level of care. Don’t go for simpler problems, ones that can be cared for the next day. Be smart about your health care.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula. Dr. McLean’s practice, Superior Foot and Ankle Centers, has offices in Marquette and Escanaba, and now the Keweenaw following the recent addition of an office in L’Anse. McLean has lectured internationally, and written dozens of articles on wound care, surgery, and diabetic foot medicine. He is board certified in surgery, wound care, and lower extremity biomechanics.