When You Should Not Go to the Emergency Room According to an ER Physician Assistant

Written by Melissa Schenkman, MPH, MSJ

What’s your go-to place for healthcare when you get sick?

For many it’s the place that they can get into the fastest, but there is a big difference between how quickly you can get into the building of the Emergency Room (ER) and Urgent Care, and how quickly you can actually receive the care you need.

While you can clearly go to any ER anytime, unless you have a true medical emergency, you may face long wait times before seeing a doctor, large medical bills, and a lack of comprehensive health management (managing all of your medical conditions  long term) because you will likely be seeing your ER healthcare provider this one visit, and they will be focused on the most pressing symptoms that brought you to the ER in the first place.

In our earlier blog, The Problem with Using Emergency and Urgent Care as Primary Care, we reported on the differences between all three of these care options that we have at our disposal and why in the long run using emergency or urgent care for non-emergency medical conditions can be more harmful than helpful–both to you and our already overwhelmed healthcare system. 

Now, Emergency Medicine Physician Assistant, Nicholas Romano, shares his firsthand take on why millennials choose to go the emergency care route, how doing so may not get you the treatment you need or are looking to receive quickly, and what can be done to address the bigger healthcare system issues, like lack of continuity of care, that arise when people make the ER their primary source of healthcare.

Plus, he gives us his recommendations for how we should and can appropriately use and choose between emergency versus urgent versus primary care. 

In your experience, what are the most common reasons you’ve observed millennials choosing emergency departments (ED) as their primary care option? Are there any specific healthcare challenges that lead them to make this choice?

Nicholas Romano: I’ve seen most young people coming into the ED, trying to use the ED as a primary provider, for a few reasons. The main one is that no one wants to wait the week or so it’s going to take to be seen by a primary care provider. They think they can just show up and get all the tests done, and that’s just not the case. It’s a lack of understanding of the purpose of the ER.

The other common reason people come to the ED and try to use us as a primary care provider is that you don’t need to pay upfront. You can be seen by a doctor, no matter your financial or insurance situation. You’ll get billed, sure, but a lot of people don’t care about medical debt and have no plans to pay it. From their perspective, it’s free. The specific healthcare challenges are obvious: lack of immediate availability of primary care providers and the lack of financial or insurance coverage.

Nicholas Romano, PA

With the availability of diagnostic tools and resources in emergency settings, how do you see this positively affecting the diagnostic accuracy and treatment decisions for millennial patients seeking primary care in these facilities?

Nicholas Romano: Depending on what the complaint is, a lot of primary care complaints will NOT get accurately diagnosed from the ER. All of our diagnostic tools and resources are set up for emergent diagnoses. If it’s a chronic condition or otherwise, it’s NOT going to be diagnosed. Many people leave frustrated because their question wasn’t answered and they’re still having symptoms. But from the perspective of an ER provider, if there isn’t an emergency going on, they’re going to discharge the patient. The purpose of the ER is to diagnose emergencies and stabilize unstable patients. That’s it.

What strategies or initiatives do you think can be implemented to mitigate the potential overcrowding and longer wait times in emergency departments, specifically for millennial patients who prefer using it as their primary care option?

Nicholas Romano: People need to be better educated on what constitutes an emergency room visit. It is NOT to be used for primary care. If you come into the ER with a primary care complaint, you’re going to wait a long time if other patients are having actual emergencies. Everything is based on severity in the ED – it is not first come first serve. Ideally, there need to be more primary care providers available and there needs to be better and affordable insurance so that people don’t have to worry about the cost of a primary care provider. There is no immediate fix, sadly. 

As a millennial physician assistant, how do you address the concern of the lack of continuity of care when dealing with millennial patients who frequently utilize emergency departments as their primary healthcare source? How do you ensure their health management remains comprehensive?

Nicholas Romano: It’s an impossible task. By nature, coming to the ED prevents continuity of care since you can’t make appointments with the same provider. Again, someone trying to use the ED as a primary care option is going to be drastically undertreated. The ED is going to look for emergencies and discharge when none are found. They aren’t going to be up to date on what preventative management needs to be done and what dosing adjustments to chronic meds need to be made.

When I encounter someone attempting to use the ED as a primary care option, I take the time to educate them on why what they are doing is inappropriate and I give them options for follow up with primary care. It’s impossible to ensure their health management remains comprehensive because again, the ED is not set up for that. The most important thing they can do is establish care with a primary care provider and STOP going to the ED.

What are your recommendations for millennials in how they should think about what it means to appropriately use emergency and urgent care versus how to appropriately use primary care services?

Nicholas Romano: If you have a legitimate concern that you are experiencing an emergency, go to the ED, no questions asked. If you think your issue is NOT an emergency and can wait a week or so, look into going to a primary care provider. I think most people can be reasonable and honest with themselves and know what an emergency is and what isn’t. I think the problem is that most people are privileged and used to the “age of now” and want immediate help. They don’t want to wait. So, they think they can use the ED for everything. Oftentimes, they end up disappointed when their issue isn’t fixed by the ED.

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