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When to See a Doctor

by Michael R. Wasserman, MD

Routine visits

Generally, everyone should routinely see their doctor, dentist, and eye doctor for preventive care. Women should routinely see their primary care doctor or gynecologist for gynecologic examinations. People can obtain a schedule of what type of care is required and how often visits are needed from their primary care doctor. Usually, infants and older people need more frequent preventive visits, but frequency also depends on a person’s health conditions. For example, a person with diabetes or a heart disorder (or risk factors for them) may need to have checkups relatively frequently.

Visits for a problem

When symptoms or other medical problems develop between preventive visits, people may be unsure whether they need to see a doctor. Many symptoms and problems can be handled at home. For example, most routine colds do not require a doctor’s attention. Many small cuts and abrasions can be handled by first cleaning them with mild soap and water, then applying an antibiotic ointment and a protective covering (see Wounds : First-Aid Treatment).

People with certain disorders should see a doctor sooner rather than later when new symptoms develop. For example, if people with a chronic lung disorder (such as asthma or chronic obstructive pulmonary disease) begin to have difficulty breathing or if people with a weakened immune system get a fever, they should see a doctor promptly. The immune system may be weakened by diabetes, human immunodeficiency virus (HIV) infection, use of chemotherapy drugs, or other conditions.

When unsure about the need to see a doctor or other practitioner, people can sometimes call their primary care doctor for guidance. Some doctors can be contacted by e-mail for nonemergency questions. Others prefer to be contacted by telephone. Doctors cannot give set guidelines for when to see a doctor and when it is unnecessary because symptoms with the same cause vary too much and symptoms with different causes overlap too much. However, some problems clearly require a call to a health care practitioner.

Some Reasons to Call a Doctor*

Problem

Reasons to Call

Cold or influenza

Vomiting or inability to keep fluids down

Painful swallowing

Coughing that lasts more than 2 or 3 weeks

Earache

Symptoms that last more than 7 days

Diarrhea

Black or bloody stools

More than 6 to 8 watery stools in children

Symptoms of dehydration (such as very dry mouth and armpits, confusion, and decreased urination), particularly in children and older people

Digestive problems

A feeling that food is stuck in the throat

Development of or change in heartburn, particularly during exercise

Frequent heartburn, belching, or regurgitation

Persistent or severe abdominal pain

Persistent nausea

General problems

Symptoms that prevent participation in usual activities, particularly new or worsened shortness of breath with exertion

Unexplained weight loss

Dizziness or an about-to-faint feeling

Persistent fatigue

Sweating, especially heavy or cold sweats

Headaches

Severe headache that peaks in intensity within seconds

Memory loss or confusion

Blurred or double vision

Slurred speech

Loss of balance or dizziness

Seizures

Numbness or weakness in the arms, legs, or face

Nausea

Heart problems

Rapid or galloping heartbeats (palpitations)

Chest pain

Leg problems

Pain in the calves that worsens when walking

Swelling in the ankles or legs

Menstrual problems

No periods by age 16

Sudden stopping of periods

A period that lasts much longer than usual or is excessively heavy

A sudden feeling of illness while using tampons

Severe or disabling cramps

Rash

Fever of 100.4° F (38° C) or above

A rash that is painful, involves swelling, or oozes

Sinusitis

Swelling or redness in or around an eye

Problems with vision

Vomiting

Moderate or severe abdominal pain

Symptoms of dehydration, particularly in children and older people

Green, black, or bloody vomit

*The list of problems and the reasons to call a doctor are only a small sample.

Visits to the emergency department

In general, true emergencies should be handled by calling 911 or the local emergency service to provide ambulance service to the nearest hospital. However, deciding what qualifies as an emergency is sometimes difficult because symptoms vary greatly. Learning as much as possible about symptoms of life-threatening disorders (such as heart attack and stroke) in advance is useful, and good judgment is often required. If the problem seems possibly life threatening, the emergency department is the place to go. The following examples clearly require a visit to the emergency department:

  • Signs of a heart attack (see Acute Coronary Syndromes (Heart Attack)

  • Signs of a stroke (see Overview of Stroke : Symptoms)

  • Difficulty breathing

  • Heavy bleeding

  • Burns that are open, char, or blister the skin; that result from inhalation; that cover a large area; or that are on the hands, face, feet, or genitals

  • Severe injury (as in a motor vehicle accident)

  • Poisoning that causes symptoms (if symptoms are minor or do not develop, the poison control center can be called first at 800-222-1222 for advice)

  • A severe allergic reaction (see Anaphylactic Reactions)

  • Shock (see Shock)

  • Sudden, severe pain anywhere

  • Vomiting blood or coughing up a relatively large amount of blood (more than a few streaks in sputum)

  • Sudden, severe worsening of a serious chronic disorder, such as asthma or diabetes

Going to the emergency department for less serious problems may be appropriate when the primary care doctor is unavailable, such as during weekends or during the night. In some health insurance plans, calling the primary care doctor first is required in order to be reimbursed for a visit to the emergency department, unless symptoms suggest a life-threatening disorder. People should know the requirements of their insurance plan before an emergency develops.

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