When do you go to a GP, specialist, urgent care, or ER?

[Anonymous]

The discussion in the ear was thread got me thinking about this question. Under what circumstances do you book appointments with a doctor (which likely involves waiting at least a few days), a specialist (which at least in DC can mean a wait of weeks or months depending on the specialty), visit an urgent care (where you can definitely get in same day), or go to the ER (also same day)?

I only recently came to have an understanding of what issues make sense for each of these categories, because I was mostly healthy until my late 30s and have since had a series of medical problems of varying severity that helped educate me. Here's my breakdown:

GP: Physicals. Also health questions that aren't urgent (I'm not in tons of pain) but don't know what specialist to see. Like when I started having increased joint pain during my hobby sport, I started with my GP who was able to figure out if it made more sense to see an ortho or a rheumatologist (they have diagnostic criteria they use to help figure out where to refer you).

Specialist: When the problem is non-urgent but I know exactly what the issue is, or at least what area of medicine it is. For instance, you technically can see a GP for migraines, but you will get much better care from a neurologist. So I will bypass GP and go straight to neurologist.

Urgent Care: Really low level stuff that needs to be handled quickly, including the aforementioned ear wax blockage. I use urgent care often for my kid when I know exactly what is needed but can't do it myself. Like if I know he has an ear infection but need an antibiotic prescription. They can also do low level wound dressings for things like a bad fall.

ER: Emergencies, obviously. Some factors I consider when determining whether I need urgent care or the ER are (1) whether I know what the problem is -- if I don't actually know what is causing the pain or other issue, ER is better because they have more diagnostic ability, (2) whether it is likely I will need a scan (including an ultrasound during pregnancy) -- urgent cares can't do scans at all usually, so no point in going there if you are going to need one, (3) if the pain is severe. I have a very high tolerance for pain which is how I found out about this last one. I went to urgent care for what I believed to be moderate abdominal pain. It was a very serious issue and they sent me straight to the ER and I was admitted quite quickly. Now I have a better sense of what kind of pain requires an ER, but I didn't get that previously.

What are your thresholds for these? I think my main takeaway is that I have learned I should see a specialist or got to the ER in more cases than I previously thought was the case. I used to think the ER was literally just for people who were actively bleeding or had a broken bone.

[Anonymous]

Chest pain or other heart attack symptoms ER. Call 911.