 And joining us now to talk about your health are Dr. Scott Berger, the Chief Medical Officer for University of Maryland Urgent Care, and Dr. Jonathan Wendell, Emergency Department Physician at the University of Maryland Baltimore Washington Medical Center. Doctors, thank you both for joining us. We wanna help people make the right decision when it's time to decide where to go for care that is somewhat emergent or urgent. Decades ago, you had a family doctor, if the doctor was closed, you're either gonna wait or you went to the emergency department somewhere. Dr. Berger, that world has changed. Yeah, over two decades ago when I was an ER resident in New York City, you know, we used to have a place called the Fast Track which was the modern, I would say, it was the precursor to urgent care now. It was a place that saw lots of patients who were coming in with non-emergency conditions that needed care and their doctor's office was closed or they didn't have a doctor to be able to take care of them. How big is it now? The industry's grown from a few thousand to close to 10,000 urgent care clinics across the country. So it's really grown quite a bit. Yeah, it seems like they're catching up with, you know, Starbucks locations just all over the place. And people may not be well prepared to make the choice. And if you have an urgent situation, you have a new website that helps people to try to decide what to do. It can be found at ummsuniversitymerilandmedicalsystem.org slash er. There's some examples on there. If you're having chest pains, you go to the ER. If somebody's having stroke symptoms, you go to the ER. But Dr. Wendell, some of these things like broken bone, the decision is still in the hands of the patient. What do you advise? I mean, I think it's really complicated. And certainly simple broken bones can often be handled at the local urgent care where they can split the patient and arrange for a close orthopedic follow-up. Certainly if it's a complex broken bone, multiple broken bones, or, you know, bones sticking out of the skin. You know, the fun stuff that we like to see in the emergency room, that's definitely the place to come is the emergency room, not an urgent care for things like that. Is it better as a general practice to overreact a little bit? If somebody's 50-50, either I don't know whether to go in or wait till tomorrow, or I don't know whether it's urgent care or the ER, should you err on the side of overreacting just because it's the safer thing to do? I think it's always important to get evaluated. The old saying that we say is that if you're concerned about it, then we're concerned about it too, and you certainly need to be checked out. I think the website provides a nice list of some things that can help you sway you one way or another of urgent care or emergency department. But certainly if you're concerned, if it's severe symptoms or things that could be dangerous like trouble breathing or chest pain, I would say err on the side of caution and head towards the emergency room rather than urgent care. Dr. Berger, from your side, how often does somebody come in with chest pains or something and it deteriorates quickly and they're leaving the urgent care and an ambulance to get to the emergency department? Fortunately, it does not happen that often. I would say that the American public is doing a very good job in general of what I would say is autotriaging themselves, making some of those decisions about where they need to go for their care. So in general, we look at about 2% of our patients wind up needing to be referred to the emergency room for higher level of care, whether it's they need diagnostic imaging and testing that we're not able to do, but they need to have it the same day, say for example, somebody who might have appendicitis or the patient that you described, somebody who's having chest pain who needs to go to the emergency room and have an evaluation by Dr. Wendell and his colleagues to make sure that they're not having a heart attack, something else very urgently needing attention. Used a good TV medical drama word triage. What does that mean? I'll defer to Dr. Wendell because this is his world really about triaging. That's right. You're deferring to my high school friends. Triage is a word that means to sort and we have very well-trained emergency nurses that specialize in the art of triage, trying to really identify those patients that need the medical care first. So I think Dr. Berger is exactly right. Most patients can auto triage. They can figure out what they need as far as urgent care or emergency department. Certainly some people think that, hey, I should probably go to the ED, but I want to be seen faster. So I just go to urgent care and then those are the ones that get ultimately sent to the emergency department anyway. So if you're thinking, hey, I should probably go to the emergency department, you're probably right, you should come to the emergency department. What can the different facilities do that maybe the others can? You think the emergency department has a CT machine, urgent care, you probably have an x-ray. Give me some examples like that. Right. So in the urgent care we're really set up for quick testing and treatment. So we're able to do a quick point of care, what we call point of care testing. So we're able to check if a child has strep throat, we're able to check for the flu, we're able to check for COVID if somebody has a urinary tract infection. And as you referenced, things like we're able to do x-rays so we can diagnose a minor broken bone, look for pneumonia, do things of that nature. Our services are really looking for things that we can take care of and treat to go home. I'll let Dr. Wendell kind of outline the full scope of the emergency room. We could be here all day. That's right. How everything they can do. I mean, I think Dr. Berger's exactly right. The biggest difference is capabilities. And we frankly have a lot more resources at hand in the emergency department. We have the ability to do more advanced blood testing that they just can't do in urgent care such as testing for heart enzymes and heart attacks, testing for liver enzymes and things like that. As far as the diagnostic imaging, we have ultrasound and CAT scan and unlimited basis MRI machines, as well as access to some specialist level care that certainly urgent care doesn't have readily at their fingertips. Related question to where to go is how to get there. And Dr. Wendell with a background in EMS, you know this from both sides. When do you take yourself to the emergency room? When do you call 911? Look, it's quite simple as we don't want a second emergency. And if your condition is going to affect your driving or potentially affect your driving, we don't want you to do it. So if you're having severe chest pain or trouble breathing, the last thing I need you to do is pass out behind the wheel and become a motor vehicle accident as well. So those are good times to pick up the phone and call 911. We have very well-trained emergency medical technicians as well as paramedics that can provide a great evaluation as well as testing and supportive care, I utilize those services. I don't want another car accident. Let's talk about the current environment a little bit. We know we had a bit of a post Thanksgiving bounce in the number of COVID cases. We know it's a bad flu year, which we haven't seen for a while. What are you both seeing in your respective operations? Yeah, I like to say that we're popular, but the short answer is it's just busy. In addition to the normal things that we see, heart attacks and strokes and the broken bones, we're seeing a whole bunch of influenza, which is unfortunate. And we have staff that has really weathered the storm over the last few years and the volumes that are coming in now is quite busy and a lot of work. So COVID and influenza, luckily RSV is going down a little bit, but all are still pretty busy. Dr. Berger? Similar, we've been very busy. It's not been as bad as last winter, but there's certainly been a significant spike over the past two to three weeks. And I think we're all just bracing for what's going to come after the holidays over the next few weeks. But in addition to all the COVID related visits that we were seeing last winter, it's that combination of all the other viral respiratory illnesses, and then people are just more active. So for us, we're seeing more of the musculoskeletal type injuries that people maybe didn't have in previous years because their kids weren't playing sports last season. And now they're out and about and doing these sorts of things. So we're seeing that too. So, as Dr. Wendell said, we've got an amazing team staffing the centers. They've grown really thick calluses in terms of being able to work long hours and see lots of people, but it's a strain on everybody across healthcare systems. Before we go, give us a little bit of advice for viewers who, you know, Christmas days away, New Year's plans out there. How do we all stay safe? My advice first and foremost is to be vaccinated, both against COVID and the flu. I am personally, when I'm out in public, I'm wearing a mask at this point in time because I do want to see my elderly parents later on this week, and I want to make sure that they're safe. I would suggest that when, before you go to family to any sort of gathering that you're testing for COVID in advance with a home test to at least make sure that you're not in that pre-symptomatic phase where you could be shedding and exposing others to the virus. Those would be my biggest points of emphasis for folks and how I'm living my life. Yeah, and I would echo what Dr. Berger said. I think now is the time to really be smart and be safe. Everything that we do is a calculated decision and a risk-benefit decision and certainly in those busy situations in crowded places, I'm in a mask as well. And as is my family, just as we said, there's a whole bunch of respiratory viruses going around and the masks are pretty good at helping us with that. And vaccinating is an excellent point. And what I would also say is that if you're sick, just stay home. There's no reason to spread any of these illnesses further, be it COVID or influenza or RSV or one of the other 100 miserable respiratory viruses that are going around right now. Dr. Wendell, Dr. Berger, gentlemen, thanks for your time. Happy holidays. I hope you're not very busy. Thank you very much. Thank you. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.