Telehealth, urgent care or the ER: how to choose
ER for anything that could threaten life or limb, urgent care when you need hands-on care today, telehealth when a conversation is enough. When in doubt between two, choose the higher level of care.
Go to the ER, or call 911, for anything that could threaten your life or a limb: chest pain, trouble breathing, signs of stroke, severe bleeding or a serious injury. Use urgent care when you need to be examined, tested or treated in person today but the problem is not an emergency. Use telehealth when a conversation, and perhaps a photo, is enough to decide what to do. When in doubt between two of them, choose the higher level of care.
The short version
- ER or 911: sudden, severe or rapidly worsening symptoms, especially chest pain, breathing difficulty, stroke signs, major injury or confusion.
- Urgent care: problems that need hands-on care or a quick test today, such as a sprain that might be a fracture, a cut that needs stitches or a strep test.
- Telehealth: mild, stable symptoms, medication questions, follow-ups, results and ongoing care where the history matters more than an exam.
- A telehealth clinician who tells you to be seen in person is doing the job properly.
- Know where your nearest urgent care and emergency department are before you need them.
When it is an emergency
Call 911 or go straight to an emergency department for:
- Chest pain, pressure or tightness, especially with sweating, nausea or pain spreading to the arm, jaw or back.
- Trouble breathing, or lips or face turning blue or gray.
- Signs of stroke: face drooping, arm or leg weakness, slurred or confused speech, sudden vision loss or loss of balance. Note the time symptoms started.
- A sudden, severe headache unlike any you have had before.
- Fainting, a seizure, or sudden confusion.
- Severe bleeding that will not stop with pressure.
- A serious allergic reaction, such as swelling of the face or throat, or difficulty swallowing or breathing.
- Severe abdominal pain, or vomiting blood.
- A significant head injury, especially with vomiting, drowsiness or confusion.
- An obvious fracture with deformity, or a bone through the skin.
- Suspected overdose or poisoning.
- A fever of 100.4°F or higher in a baby under three months old.
For suspected poisoning that is not immediately life-threatening, Poison Control is available at 1-800-222-1222. For a mental health crisis, including thoughts of suicide, call or text 988, the Suicide and Crisis Lifeline. If someone is in immediate danger, call 911.
Do not drive yourself if you have chest pain, stroke symptoms or anything that could make you lose consciousness. Call 911. Paramedics can begin treatment on the way.
Be careful here
Do not book a video visit to ask whether an emergency is an emergency. Booking, waiting and explaining costs time that matters for heart attacks and strokes. If you are seriously wondering whether to call 911, call.
When urgent care fits
Urgent care centers treat problems that need attention today and benefit from an in-person exam, a quick test or a simple procedure, but are not life-threatening. Typical examples:
- A sprain or injury that might be a simple fracture and needs an X-ray.
- A cut that may need stitches.
- A sore throat where a rapid strep test would settle the question.
- Ear pain, particularly in children, where someone needs to look in the ear.
- Minor burns.
- Symptoms that need a quick in-person check, such as a cough with a fever that has not improved.
Urgent care centers cannot manage true emergencies. If an urgent care clinician tells you to go to the ER, go.
In some areas, freestanding emergency departments look much like urgent care centers but are emergency facilities and bill accordingly. Check what a facility is before you walk in, unless you need emergency care.
When telehealth fits
Telehealth works when the answer depends mainly on what you can describe, and perhaps show on camera, rather than on what a clinician needs to touch or test. Common examples:
- Mild cold or flu symptoms in an otherwise healthy adult.
- A rash or skin problem that can be photographed clearly, although some need an in-person look.
- Medication questions, refills and side effects that are not severe.
- Follow-up visits and reviewing lab results.
- Ongoing care for chronic conditions, weight management, hormone therapy and mental health care when you are not in crisis.
A careful telehealth clinician will ask enough questions to recognize when a problem is beyond what a video visit can handle, and will send you elsewhere. That limit is explained more fully in what telehealth is actually good for, and what it isn't.
Specialty telehealth is not urgent care
Practices that provide ongoing specialty care by telehealth, such as weight management, hormone therapy, medical cannabis evaluations or ketamine therapy, are not set up to handle sudden illness or injury. They are the right place to ask about side effects of a treatment they prescribed, as long as the side effect is not severe. They are not the right place for a new acute problem.
If you develop a severe reaction to a medication, such as trouble breathing, swelling of the face or throat, severe abdominal pain or chest pain, call 911 first and let the prescribing practice know afterward.
What about cost?
Emergency departments usually cost the most, urgent care less, and telehealth often least, though it depends heavily on your insurance. Cost should never stop you from going to the ER for a true emergency. Under the federal EMTALA law, hospital emergency departments that participate in Medicare must screen and stabilize anyone who arrives with an emergency medical condition, regardless of ability to pay. The No Surprises Act also protects most insured patients from surprise out-of-network bills for emergency care.
For non-emergencies, choosing the right setting can save both money and time. Our post on what a telehealth visit should cost covers how to compare prices.
If you are not sure
Many health insurers and primary care practices run nurse advice lines that can help you decide where to go. Your insurance card often lists the number. If you have a primary care doctor, their office may be able to see you the same day or advise you by phone.
Plan ahead
Look up your nearest urgent care center and emergency department now, including their hours, and save them in your phone. If you live in a rural area, know how far the nearest ER is. Our post on telehealth in rural Michigan discusses why that planning matters.
A quick way to decide
- Could this threaten my life, a limb or my eyesight, or is it getting worse quickly? Call 911 or go to the ER.
- Does someone need to examine, test or treat me in person today? Go to urgent care, or see your doctor the same day.
- Is it stable, and would a conversation be enough to decide the next step? Telehealth is a reasonable choice.
For ongoing care that does fit telehealth, such as weight management or stress and anxiety care, a scheduled evaluation is the right starting point.
Questions patients ask us
When should I go to the ER instead of urgent care?
Go to the ER, or call 911, for anything that could threaten life, a limb or eyesight, or that is getting worse quickly. That includes chest pain, trouble breathing, stroke signs, severe bleeding, a serious allergic reaction, a significant head injury, sudden confusion or a seizure. Urgent care centers are not equipped for true emergencies.
What are the warning signs of a stroke?
Sudden face drooping, weakness or numbness in an arm or leg, slurred or confused speech, sudden vision loss, or sudden loss of balance. If you see any of these, call 911 immediately and note the time symptoms started. Treatment for stroke is time-sensitive, so do not wait to see if symptoms pass and do not book a video visit.
What can urgent care do that telehealth cannot?
Urgent care can examine you in person, run quick tests such as a rapid strep test, take X-rays at many locations, stitch cuts, splint sprains and treat minor burns. Telehealth cannot touch, test or image you. If the answer depends on an exam or a test, urgent care or a same-day office visit is usually the better choice.
What conditions can be treated by telehealth?
Telehealth suits mild, stable symptoms and ongoing care where the history matters more than a physical exam: minor cold or flu symptoms in a healthy adult, some rashes that can be photographed, medication questions, follow-ups, lab result reviews, and ongoing care such as weight management, hormone therapy and mental health care when you are not in crisis.
Should I call my specialty telehealth practice about a medication side effect?
Yes, if the side effect is new but not severe. The practice that prescribed the medication should hear about it. If the reaction is severe, such as trouble breathing, swelling of the face or throat, severe abdominal pain or chest pain, call 911 first and let the prescribing practice know afterward.
Will the ER treat me if I cannot pay?
Yes. Under the federal EMTALA law, hospital emergency departments that participate in Medicare must provide a medical screening exam and stabilizing treatment for an emergency medical condition regardless of ability to pay or insurance status. Billing comes afterward, and many hospitals have financial assistance programs you can ask about.
What is a freestanding emergency department?
It is an emergency facility not physically attached to a hospital. In some areas these look much like urgent care centers but operate and bill as emergency departments, which usually costs more. If you do not need emergency care, check what a facility is before you walk in.
Who can I call if I am not sure where to go?
Many insurers and primary care practices offer nurse advice lines, and the number is often on your insurance card. Your primary care office may also advise by phone or see you the same day. For suspected poisoning, call Poison Control at 1-800-222-1222. If it might be an emergency, call 911.
Is it safe to drive myself to the ER?
Not if you have chest pain, stroke symptoms, severe bleeding or anything that could make you faint or lose consciousness. Call 911 instead. Paramedics can begin treatment on the way and alert the hospital. For less serious problems, have someone else drive if you can.
Where should I go for a mental health crisis?
If you or someone else is in immediate danger, call 911 or go to the nearest emergency department. For thoughts of suicide or a mental health crisis, call or text 988 to reach the Suicide and Crisis Lifeline, available around the clock. A scheduled telehealth appointment is not the right place for a crisis.
Talk to a licensed clinician
Reading about a treatment is not the same as knowing whether it fits your history. A consultation is a conversation about your own situation — not a sales call, and not a promise of any outcome.
