By Ns1ghter Provider: William Jantsch, MD; Emergency Medicine, Internal Medicine

The human body is a remarkably constructed mechanism which, if properly nurtured, will serve its owner well for many decades. Things do go wrong, on occasion, and the medical profession has developed over centuries to try to help sick and injured people with their illnesses and debilities. Even with incredible scientific advancements, however, there are still major gaps in medical knowledge, associated with multiple controversies.

Modern healthcare in the United States is a gargantuan, intimidating process that unfortunately has lost sight of its primary objective- that is, to relieve suffering and to improve the quality of life for individuals. Primary doctors, such as Family Practice, Pediatric, and Internal Medicine specialists try to help their patients through the maze of confusing and often conflicting information that is available to almost anyone with a web browser.

But whom do you believe?

I certainly do not profess omniscience, but here is what I can recommend:

a. If you have a primary doctor whom you trust, and who is available to answer your questions, you are lucky. You will know in your gut when your concerns are taken seriously, and recommendations will make logical sense. If something doesn’t seem to make sense, ask about it. A good doctor is open to questions, and will even revise advice based upon your preferences and circumstances.

b. If you don’t have a primary doctor, you have some options:

c. On-line web searches

d. Telehealth chat (such as Ns1ghter)

e. Urgent Care centers

f. Hospital Emergency departments

g. Asking your (best friend, mother…)

Here are the advantages and disadvantages of the above options (briefly)

a. On-line searches are free, and easy, readily available. There is so much information at times, however, that it is difficult to apply it to your personal problem. You also run the risk of over-diagnosing serious conditions, that just adds to your worry. You will not be able to order tests or prescribe treatments in most cases.

b. A telehealth chat is another low-cost, easily available option. With a service like Ns1ghter you can ask a question and get a doctor’s opinion very quickly.  Ns1ghter can also provide face-to-face contact with a doctor who can suggest and prescribe medication for some straightforward medical conditions. For instance, if you know you have a bladder infection based upon symptoms that are familiar to you, and all you need is an oral antibiotic, then Telehealth is a good option. I would be cautious of any service that says it can confidently diagnose and treat a wide variety of medical disorders, such as ankle injuries, earaches, abdominal pain or trouble breathing.

c. An Urgent Care Center is basically the doctor’s office, but without the ability to provide on-going care. This is a really good option for earaches, asthma attacks, sudden fevers, and minor injuries. Most Urgent Care Centers have some degree of medical testing, and possibly even x-ray capability.  The expense to visit an Urgent Care is often just a fraction of what an Emergency Department visit would be at the hospital. However, Urgent Care is not a good option for potentially serious problems, such as severe abdominal pain, chest pain, or possible stroke.

d. The hospital Emergency Department is designed to handle all emergencies. This is the place you want to be if you are having a stroke or a heart attack. This is where you will go if you call 911 and get transported. However, if you go to the ED without an obvious acute medical emergency, you may have to wait a long time to complete your assessment, and the charges to you or your medical insurer will be very high.

There are no easy rules to help you to sort out which option to choose! So here is what I hope would be some common-sense advice:

- If you feel a sudden, severe change in your medical condition that you can tell is “very wrong”, call 911 and/or get to an Emergency Department immediately.

- If you can sense something does not feel right, but is progressing gradually and slowly, make use of your “free” options first: look to the Internet for information, and contact a Telehealth chat service for help with the best way to proceed with your evaluation.

- If you start a Telehealth video chat or go to an Urgent Care Center, and the practitioner does not feel that he or she can diagnose and treat you appropriately in that setting, you may be directed to the Emergency Department. That’s OK, it’s difficult even for doctors to know where to go initially for medical assistance.

The most important thing is that you get the best medical care available to you. Don’t be afraid to ask questions, and research on-line to the extent you feel comfortable. Contact the Telehealth chat service. That should get you started in the right direction.