“Could I just call Teladoc and have them order the MRI of my arm?” My husband asked recently after he tore his biceps tendon. He’s always manipulating where to go when he gets sick in his head. He asks me but he has formulated a plan.
He asked this in between screams of pain – the screams that he would later claim to the orthopedic surgeon never occurred. Typical man. He also wanted me, his wife on the same insurance policy, to order the MRI but that’s another story all together.
“Umm, no dear. They don’t do that sort of thing,” I responded.
“Well, I know that it costs less of a copay to go through them with my company insurance,” he responded. “What DO they do?”
This conversation, though a little more health-care guided than most, is far more prominent today than it was in the past with SO many health care options available.Telemedicine, your primary care Doctor’s office, urgent or immediate care, stand-alone emergency rooms, and hospital-attached emergency rooms – where do you go for what?
Here’s a break down of what is traditionally available through these different health care locations:
This involves either telephone, text, or video chats with a physician who is located elsewhere. Most are in the United States and certified in many different states. Interestingly, Doctors have to be credentialed in the state the patient lives in to be able to treat them, not where the Doctor is physically located.
Nearly all visits are acute or sick visits. There are limited issues that physicians can treat without actually “seeing” the patient and based off of reported symptoms. These include sinus infections, colds, stomach bugs, etc. Rashes usually require at least a picture but those can be sent electronically as well. The goal through telemedicine is to TREAT or give advice on these issues and to DIRECT patients whose symptoms seem more serious to seek further care when needed.
Telemedicine Doctors are limited in scope and the visits are typically less expensive than in person visits. Insurance may make your copay less expensive or it may just be a cash pay option not covered by insurance at all. The vast majority will not order lab, testing, or imaging. Even if your crying husband is requesting a very specific MRI – an exam is necessary before that occurs.
Primary Care Doctor’s Office
This is typically called the “medical home.” And it should be that. This is where you receive treatment for your chronic diseases, such as diabetes, high blood pressure, etc. You should receive a yearly physical exam there to help maintain good health. When you are sick and need to be seen, you should be able to go to your primary care office as well. The shortage in primary care Doctors has made this ability variable, though, and opened the door for other treatment facilities. Equally, what sick services you can receive at your Doctor’s office varies based on the resources available.
At my Family Medicine office, we can obtain x-rays, CT scans, MRI scans, ultrasounds, EKG, etc. At my previous office, we could only obtain lab. X-ray and anything further would go to the hospital or radiology offices. It would be ordered, directed, and results received by your primary Doctor, though.
Keep in my that just because it is available, it does not mean that we can get insurance approval for the same day at a primary care office. An MRI, for example, may take a few days for approval. So, low back pain MRIs make sense at your primary care office but CT scans for appendix or kidney stones are more difficult to get in a timely manner.
Urgent or Immediate Care
These offices are typically staffed by mid-level providers (Nurse Practitioner or Physician Assistant) with an overseeing Physician and provide nearly all acute or sick care. They are open when your Doctor’s office is not. And access is walk-in. That helps if your Doctor’s office is full and you need to be seen for something like strep throat. They have nearly the same services available as your primary care office. Most Urgent Care clinics can obtain lab, EKG, and x-rays but CT/MRI and more urgent scanning is typically sent to the Emergency Room. They do not treat your ongoing medical conditions but are usually open to refilling medication for a short time should you need it.
Stand-alone Emergency Room
This is a traditional emergency room with one exception: it isn’t physically attached to a hospital. Emergency rooms are the place for your more sick visits. Please don’t go the emergency room for your cold, strep throat, or ear infection. It is more expensive to begin with and the assumption in going to the ER is that you are sick enough that you may require hospitalization to treat whatever you have. They have access to everything including IVs, scans, labs, etc. If you think you are having a heart attack, head to the ER. Don’t call or walk into your Doctor’s office.
The biggest limitation with stand-alone emergency rooms is that the rest of the hospital is not attached. If you need to be hospitalized (usually the expectation in the ER), you will have to be transported to the hospital. The goal would be to make sure you are stable before transport but, obviously, this process takes longer when you have to be moved.
Hospital-attached Emergency Room
They have it all and they need it. If you show up with appendicitis, they can get your IV, get your CT scan, and get you into surgery in the same location. And it won’t take days for insurance approval to get the scan. Just remember the word EMERGENCY. It is more acute, more expensive, and should be saved for emergencies. Let’s try not to clog the system with non-non-emergent issues.
Let’s look at a few examples and where to go:
- Your child has a fever and earache: Try your Primary Care office first. If after hours or they are full, this would be a telemedicine or urgent care visit.
- You have poison ivy: Telemedicine, Primary Care office, or urgent care could treat this.
- You husband is struggling with erectile dysfunction: Get an appointment at your primary care office. Ongoing or chronic issues are best treated there for continuity. Many telemedicine companies do not prescribe more controlled medications as a policy.
- You have burning with urination: Most telemedicine will treat this off of symptoms and a known history as patients are typically good at knowing once they have had a few. Your Primary Care office or urgent care are also good options.
- Your blood sugars are running high at 200 but you feel fine – This will typically be managed through your primary care office. If after hours, consider urgent care.
- Your blood sugars are running 400 and you are feeling “out of it”: Emergency room as you will need urgent lab work and IV fluids.
- You ran out of your blood pressure medication: Call your Primary Care office during office hours. This is only emergent if you have not prepared. Typically primary care offices like 48 hours for refill requests in order to prevent this from occurring.
- You have been out in the sun in the heat. Your heart is racing and you have not urinated all day: Stand-alone or hospital-attached Emergency Room are appropriate as you will need IV hydration but may be able to go home without hospitalization is you recover quickly.
- You have chest pain like someone is sitting on your chest: Go to a hospital-attached Emergency Room. Stand-alone is fine if you are a long distance from a hospital-attached ER but you are likely going to be admitted and require intervention. The quicker, the better.
Simple Solution: Knowing how to navigate the new world of medical care will help you get to the correct place, save time and money, and potentially save your life. Follow these tips and you will find it easier to get there in the first place.
For more Blog Posts on My Husband’s Health Care: https://doctormome.com/cbd-oil-a-doctors-experiment/