October 28, 2015

ER or walk-in clinic? How to make the call


Emergency room vs. Walk-in Clinic: Making the choice can be tricky. Here are important points to keep in mind.

Chest pain. Shortness of breath. Changes in mental status or abrupt changes in strength, vision or sensation. Significant injury or severe pain of any kind.

These are all clear signs that a person should consider a trip to the emergency room.

But a walk-in or urgent care clinic can handle a variety of conditions that many people might not realize when they are in the throes of assessing a sick or injured loved one.

“Our clinics have changed with time,” said Deb McCroskey, M.D., director of Vanderbilt Walk-In Clinics. “We used to see mostly colds, sore throats, urinary tract infections, but we now see minor car accidents, patients with abdominal pain. Sometimes it’s like a miniature emergency room.”

Conditions including persistent rashes (without shortness of breath), colds and flu, insect bites or ankle sprain almost never require hospital emergency care. The jointly operated Vanderbilt Health and Williamson Medical Center Walk-In Clinics and the Vanderbilt Walk-In Clinic in Belle Meade, for example, are staffed with board-certified physicians, perform some minor procedures and are equipped to perform a wide range of diagnostic testing including X-rays, lab testing and EKGs.

Going to such a higher-level walk-in clinic can result in shorter waits times for more appropriate, less expensive care.

But between obvious signs that a person does or does not need emergency care is a big gray area, McCroskey said. Judgment depends more on severity and whether other symptoms are present. A fever doesn’t automatically mean a trip to the ER, but a fever with a severe headache and changes in mental status does.

Sorting through it all can be confusing for people without medical backgrounds.

“Almost any complaint can have a spectrum where that complaint can be potentially serious,” said Ian Jones, M.D., of Vanderbilt University Medical Center’s Department of Emergency Medicine. “The good thing is that the urgent care centers can often pick up on things and if they need to, can refer to the ER.”

Jones said making a list of all conditions that should trigger a visit to the emergency department is difficult, but life-threatening symptoms of heart attack and stroke such as chest pain, shortness of breath and difficulty with vision, speech and weakness of the arms or legs are among them. This is especially important since early recognition and treatment of a heart attack or stroke can be life saving. Refresh yourself on all the warning signs here.

Calling your primary care physician or a nurse line is a good way to get advice on where your problem should be handled. But for diagnosing, McCroskey said, “Seeing the person and how they are acting is crucial.” Vanderbilt’s walk-in clinics don’t advise over the phone for this reason.

“It’s good to get a set of trained eyes on you,” Jones agreed. “It really is much better to be able to talk to people, ask questions and conduct an exam. That gets you much further than just hearing about it.”

Both physicians urge caution about searching symptoms on the Internet, which causes some patients to become convinced they have something more serious than they do. There is a also wide variety of conflicting information available on the internet that may also lead some individuals to misinterpret concerning signs and symptoms.

“When you scan for symptoms on the internet, you automatically focus on the worst illness on the list,” McCroskey said. “Then the anxiety kicks in and you get more symptoms. By the time you come in to the clinic, its impossible to figure out which symptoms are real and which are psychological.”

But whether you choose a walk-in clinic or emergency room, neither are substitutes for having a primary care physician who takes a holistic approaching to managing your care on an ongoing basis.

Vanderbilt Walk-In Clinics, for example, don’t manage birth control or other long-term care medications for cholesterol, diabetes, blood pressure, pain and anxiety. Primary care physicians are also best equipped to handle matters such as morning after pills, impotence, ADD/ADHD medications and weight loss – and other matters requiring ongoing maintenance.

“We’re seeing lots of people who only get care when they are sick,” Jones said. “It’s really important to get care when you’re not sick, so when you do get sick, the care is better. You’ve got someone who knows you.”

Walk-In Clinics

Vanderbilt Health and Williamson Medical Center jointly operate walk-in clinics in Middle Tennessee staffed with board-certified Vanderbilt physicians, and Vanderbilt offers care at other locations all over Middle Tennessee. Find a location near you, here.

Here is a sample of what these walk-in clinics can treat:

Common illnesses and minor injuries

Animal bites
Back pain/strains
Bladder infections
Bug bites
Ear infections
Eye infections
Flu and colds
Poison ivy
Sinus infections
Sore throats
Stomach bugs


Detailed examinations for:
Adoption physicals
Camp/sports physicals (not school physicals)
Department of Transportation (DOT) physicals
Pre-employment physicals


Hepatitis A/B

Screening and testing

Breathing treatments
Drug screenings
Lab testing
Pregnancy testing
STD testing
TB skin testing

Vanderbilt’s Children’s After-Hours Clinics offer the convenience of a walk-in clinic with care provided by a board-certified pediatrician from Children’s Hospital. No appointment is necessary, but we recommend calling your pediatrician first. Learn more about services and find locations for Children’s Hospital After-Hours Clinic here.