Linda Kintz, MD, a physician at Emerson’s Hudson and Littleton urgent care centers, answers questions about the different types of issues she treats and which serious ailments are more appropriate for an emergency room.
Can most musculoskeletal problems be handled at an urgent care center?
We can handle the vast majority of musculoskeletal problems, such as back pain or concern about a fall or a sports injury, and can rule out a ligament tear or a fracture with an x-ray. We can then perform bracing and splinting. If a cast is needed, you will be referred to an orthopedic surgeon. People are often surprised that we can help them with shoulder dislocation; in many cases, we can numb the shoulder with lidocaine and maneuver it back into place.
In general, lots of people come to urgent care with sprains or strains and need a diagnosis, as well as guidance on how to change their activities while they heal. Also, we suggest ice or heat — typically ice for an acute joint injury to reduce inflammation and heat for muscle strains.
What about when a cold or the flu is getting worse?
If a cold or flu has not improved or worsened after a week — and you can’t easily get an appointment with your primary care physician — you should come in. We might prescribe Tamiflu, and you may feel better. If someone smokes or has a lung condition such as asthma, they are at higher risk of bronchitis and pneumonia. I would say that anyone over age 75 who has a fever at any time needs to be seen. We can assess dehydration, especially in children and older individuals.
Are there health symptoms that are more appropriate for an emergency department, rather than urgent care?
There are two broad areas where we can’t rule out a serious condition in an urgent care setting. The first one is chest pain, especially if there is a concern about heart attack. Some people have a history of anxiety or asthma that produces the symptom of chest pain. But if someone has chest pain, has never had it before and is over age 50, they should go directly to the emergency department [ED], where the staff can perform the various tests that may be needed. We can perform an EKG [electrocardiogram], which is helpful, but a heart attack can evolve, and it can take several hours to diagnose it. The patient will receive the care they need, more efficiently, in an ED.
The other area has to do with neurological symptoms, such as confusion, problems with speech or sudden weakness in the limbs. This can indicate a stroke, and the ED is the right place to diagnose and treat a stroke. People also arrive with suspicion of a concussion. In about 25 percent of cases, the concussion is mild, based on our assessment of the patient’s symptoms. But if someone has a headache, nausea and is over age 65, they may need to have a CT scan performed, and the ED is the right place.
Are there problems urgent care is right for, and people may not realize it?
Nosebleeds come to mind. If you have been applying pressure for at least 45 minutes, and you are still bleeding, you should come in, because you can lose a lot of blood. We will use nasal packing to stop it for good. People come in with foreign objects in their noses or ears; we can remove those safely. We perform ear cleanings, which are necessary when wax has accumulated to where the individual can’t hear.
Cuts and lacerations need emphasis, because we are very good at performing suturing. If bleeding has continued for more than 45 minutes, the wound will likely need suturing and should be seen. Depending on where the cut is, we will assess for tendon damage. We treat urinary tract infections in men and women, as well as vaginal infections and menstrual problems in women.
Will my health plan cover the cost of my visit to an urgent care center?
The answer is almost always yes. If your health plan is an HMO, you will need to obtain a medical referral from your primary care physician after your urgent care visit.
For more information on the Emerson Urgent Care Centers in Hudson and Littleton please call 978-287-8990 or visit emersonurgentcare.org.