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When should you go to the emergency room?

How to get the care you need when you need it

Tufts Health Plan
When should you go to the emergency room?
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It can happen when you least expect it. You fall and can’t put weight on your leg. You spike a high fever. Or you have a rash that’s getting worse. These are examples of situations that may have you wondering if you need care right away, and if you do, where you should get that care.

David Elvin, M.D., chief medical officer, Tufts Health Plan, says planning ahead can make these situations less stressful. Here he answers questions many people have about what to do when they have immediate health care needs.

Q: How can I make sure I or my family members get the right care if we have an unexpected health concern?

David Elvin, M.D., Chief Medical Officer, Tufts Health Plan

A: Many people go to the emergency room when they are sick or injured because they don’t have a health care provider and don’t know where to go. They may have been assigned a primary care provider (PCP) when they enrolled in a health plan but haven’t seen their PCP yet because they were healthy. When something happens and they try to see their PCP, there’s a lot of pressure on patients and providers. It may be hard for them to get the care they need right away because their PCP doesn’t know them or their health history.

I encourage everyone to make an appointment to see their PCP before health problems arise so they can get to know each other. Patients can tell their PCP about any health conditions they have, medications they take, their personal and family health history, etc. They can ask what their PCP recommends if they face an urgent situation at night or on weekends. Your PCP may suggest that you go to an urgent care center or an emergency room in the same health system so the provider you see will have access to your medical records.

What should I do when I think I need care right away?

If you’re having a medical emergency, call 911 or go to the nearest emergency room. Examples of symptoms that may be serious include chest pain, difficulty breathing, trauma, drooping on one side of the face and uncontrolled bleeding.

Many people who go to the emergency room are worried about a health issue and not sure if they need immediate care. In cases like this, I recommend calling your PCP’s office and explaining your situation. Most PCP’s have a 24-hour phone line so even at night they can help you decide whether making the trip is a good idea.

How can my PCP help if I need care right way?

Your PCP or their team member can talk with you about what’s going on and give you advice about what to do next. Some PCP practices offer urgent care services or have a relationship with an urgent care center in the neighborhood. If not, they may suggest that you come to the office for a same-day appointment, make an appointment to see your PCP within the next few days, or in some cases go to an urgent care facility or emergency room.

I know that sometimes it can be hard to get through to your PCP on the phone. When you talk with your PCP ahead of time about what do you when you need immediate care, you can follow their advice about where to go. If for some reason you don’t hear back from your PCP’s office and you aren’t sure what to do, call an urgent care center or emergency room close to you and ask for advice.

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What if I need to talk with my PCP after hours?

You can still call your PCP’s office if you need help after normal office hours. Most PCP offices have an on-call provider who can help you understand what’s happening and tell you the best way to get the help you need. Your health plan may also offer resources. At Tufts Health Plan, for example, many of our plans have a number you can call 24/7 to talk with a nurse who can help you decide where and when to get care.

I recently went to the emergency room for care. They told me to follow up with my PCP. Do I need to do that if I feel well?

Yes. It’s important for your PCP to know all the health issues you have so he or she can provide you with the best possible care. Whenever you get care in an urgent care center or emergency room, ask them to send your PCP information about your visit. This is especially important if they change any of your medications. Your PCP may need to evaluate your progress, continue your treatment and/or take other steps so you don’t end up back in the emergency room.


Care management

Go to the ER often for the same problem?

If you need urgent or emergency care to manage a complex health condition, ask your primary care provider or your health insurance plan if you should be working with a care manager. A care manager can help coordinate your care and help you navigate important appointments. They can be especially helpful if you see many providers.

At Tufts Health Plan, care management is an integral part of all of our plans. Our care managers play a vital role on our members’ care team. If you are assigned a care manager, they will:

• Meet with you in a way that works for you

Get to know you to understand and help you meet your health/wellness goals

• Coordinate care between your PCPs, specialists, community services and other providers

• Help you navigate social supports or apply to get other services — such as food stamps and stable housing — if you need them to support your health and well-being


Tufts Health Plan is one of the few health plans in Massachusetts to offer coverage across the life span regardless of age or circumstance. This coverage includes Medicaid/subsidized, commercial and Medicare health plans. To learn more, visit TuftsHealthPlan.com.