Nora misjudged the height of the stair outside the restaurant, stepped down too hard, jammed her knee and tore her meniscus. Not that we knew this at the time. All we knew then was that she was howling from the pain.
There we were on a dark, empty, wet street in lower Manhattan, not a cab in sight, with a wailing, immobile woman. What to do? Call 911? Find a cab to take her home and contact her primary care doctor for advice? Take her home, put ice on her knee, feed her Advil and call her doctor in the morning?
Sometimes it is clear that the only response to a health crisis is to call 911 and head for the emergency department (ED). But in this case – and in so many others we encounter with our kids, our parents, our co-workers and on the street – the course of action is less obvious, while the demand for some action is urgent.
The question “which action?” has become more complicated of late because:
- In some communities, there are alternatives to an ambulance or a drive to the nearest ED, such as Urgent Care centers.
- Disincentives exist for going the route of the ED: in many cash-strapped municipalities we are charged for the cost of ambulance ride; we risk not having our ED visit covered by insurance if we make the wrong decision or fail to notify our health plan in a timely manner. Or we don’t have insurance and the ED care is expensive.
- Some of us have a number of clinicians who could guide us about ED versus self care on any urgent health matter, plus our health plan may have a nurse advice line that could do the same. Which among them to call? How long will it take to get an answer in the middle of a busy workday or a late night?
- Many of us have no primary care clinician to call. Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*