Where to go when you need medical care

If you think you’ve broken your arm or have a child with a fever, you may not know where to go for the right care. There are many choices for getting medical help, like going to a nearby hospital, emergency room (ER), urgent care clinic, or seeing your primary care doctor in-person or virtually.

“The fundamental rule is to use your best judgment,” says Benjamin R. Leavy, M.D. He’s a family and community medicine doctor at UC Davis Health in Sacramento. You can always call your primary care doctor’s office for guidance, he explains. And if it’s outside of their office hours, many health plans offer a 24-hour nurse advice line. Calling this line will connect you to a nurse who can provide recommendations and direct you to the right place.

When you’re ready to find care, here is a general guide of where to go and when. Just remember, everyone’s situation and symptoms will be different.

When to go to the emergency room

“The emergency room is where you go when something serious happens and you need care right away,” says David Kim, M.D. He’s the CEO of MemorialCare Medical Group’s Medical Foundation and Clinical Institutes in Fountain Valley, California. But when it’s hard to decide, “there are certain signs that you should go straight to the ER,” he says.

These include:

• Signs of a heart attack: pain or discomfort in your chest; lightheadedness, nausea, or vomiting; jaw, neck, or back pain; discomfort or pain in your arm or shoulder; shortness of breath.
• Signs of a stroke: face drooping, arm weakness, slurred speech.
• Having “the worst headache in your entire life,” says Dr. Kim. That can be a sign of a brain bleed.
• Difficulty breathing.
• Sudden severe pain.
• Sudden loss of vision in one or both eyes.
• Choking.
• Severe burns.
• A head injury that caused unconsciousness.
• Deep cuts that won’t stop bleeding.
• Severe vomiting or diarrhea, which may include blood.
• Broken bones (and a bone and joint specialist’s office is closed).

If you have symptoms of a heart attack or stroke, always call 911. If you have any of these other symptoms, call 911 or ask a loved one to take you to the ER.

Dr. Leavy points out that there is a difference between something that’s considered a “social emergency” and one that’s a “medical emergency.” For example, he says if you have mild diarrhea and are leaving for a trip later that day, you may want to get help ASAP so you can make your flight. But the ER would not be the right place to go. Why? There’s no risk of long-term harm and your life isn’t in danger. It’s best to save the ER for those types of emergencies, notes Dr. Leavy.

When to go to urgent care

“Urgent care is right for situations when something isn’t alarming, but you don’t feel like the problem can wait,” says Dr. Kim. However, urgent care may not have all the same equipment and testing capabilities that an ER does. So, if you go there with a health emergency, like chest pains, difficulty breathing, or a splitting headache, they will likely send you to the ER or call 911.

A visit to urgent care could cost you less than going to the ER. Before heading to urgent care, check our Find a doctor tool to find nearby urgent care centers that are in-network so you can save on out-of-pocket expenses.

Consider going to a local urgent care when:

• You have a cut that may need stitches but has mostly stopped bleeding.
• You have a sore throat or cough.
• You think you’ve sprained or broken something. Urgent care doctors can take X-rays to check if a bone is truly broken.
• You have a mild burn.
• You think you have a urinary tract infection (UTI), and your doctor’s office is closed.
• You have a fever and your doctor’s office is closed.
• You have mild nausea, vomiting, or diarrhea.

When to try virtual care

Virtual care refers to a doctor's visit you can do through your computer, phone, or tablet. You can see your own primary care provider or PCP (if they offer virtual care) or use a telemedicine service. Virtual care is especially convenient when you’re sick because you can see your doctor without leaving home. When scheduling a virtual visit, log in to your online member account to see if it’s available under your plan.

Schedule a virtual visit for things like:

• An annual checkup
• Prescriptions and refills
• Cold or flu symptoms
• Rashes or breakouts
• Mental health checks
• Sexual health consultations
• UTIs or other infections
• Weight loss treatment
• Preventive care recommendations, including health screenings
• Check-ins for well-controlled chronic health conditions

When to call your primary care doctor

Your primary care doctor, also known as your primary care physician or PCP, is often one of the best people to call first, says Dr. Kim. That’s why developing a relationship with your PCP through yearly checkups is important. When they know you and your health background, they can advise you on concerns, big and small.

Call your doctor when:

• It’s time to schedule your annual checkup.
• You have symptoms that you’re concerned about, but they are not life threatening. That might include an earache, weight changes, trouble sleeping, or new or worsening seasonal allergies.
• You are managing a chronic health condition such as diabetes, high blood pressure, or thyroid disease and you need routine care.

If you have a health need, locate a nearby ER, urgent care, in-person, or virtual care using our Find a doctor tool.

^{Blue Shield of California does not provide medical or dental advice. This information is for informational purposes only.}