My mom needs to go to a doctor. What kind?

July 6, 2021 8:28 AM

My mom (a retired nurse) has not been to a doctor for at least 30 years. She needs to go to one now. Is this an ER, urgent care, or other doctor situation?

My mom (72, US) has been very stubborn/fearful about going to a doctor all my life. Her health isn’t great (mostly sedentary at home alone, very overweight, smoker, arthritic). I live far away so I haven’t seen much since the pandemic. Yesterday I found out she had been hiding a problem with her foot/leg— for about a week she can barely walk on it and the front 3 toes are red and swollen like they have blood trapped under the surface. This doesn’t sound good, so I am flying back tomorrow to take care of her and finally get her to see a doctor.

A lot of the advice seems geared to ‘see your pcp’ but she doesn’t have one. Or a lot of my searching presents dementia patients- she’s sharp and lucid as ever. But I’m not sure if this is an ER situation or an urgent care one or something else? I’m a little overwhelmed (she’s my last family member) so I could use some outside perspective as I wade into this.

posted by actionpact to Health & Fitness (36 answers total)

In non-pandemic times and without a family doctor to go to, I would definitely think that ER worthy. I am not a medical professional of any sort. Obviously there IS a pandemic, so I might be more ER wary...but if she doesn't have a family doctor, then I don't see another option here. I think she should mask up and head to the ER today, not even wait for you. If it's a blood clot it can go south very quickly if it dislodges.
posted by If only I had a penguin... at 8:32 AM on July 6, 2021 [2 favorites]

ER. This could be an embolism. If she'll go before you arrive (and I understand she may not), she should actually do that. Honestly, if you can move your flight up without freaking her out into non-cooperation, I would.
posted by praemunire at 8:33 AM on July 6, 2021 [18 favorites]

I'd take her to Urgent Care when you get there, getting a PCP assigned and a first appointment may take a while. If she's comfortable with it I'd attend the urgent care appointment with her, at least in my family that's made it easier to get a grasp on what the current situation is without some of the instinctual minimization of things that our family has.
posted by iamabot at 8:34 AM on July 6, 2021 [5 favorites]

Yup ER for this. If she absolutely will not, or if the ERs where she is are fully overwhelmed at the moment, then Urgent Care (even if they only end up saying this is a case for the hospital).
posted by We put our faith in Blast Hardcheese at 8:34 AM on July 6, 2021 [3 favorites]

If she doesn't have a regular doctor, it's unlikely that she's going to be able to get an appointment with one quickly. Urgent Care places are great for some things, but not equipped to handle more than common basic things (colds, flu, sprains, broken bones, cuts), so it seems like an ER would be the most thorough option. The Urgent Care place may send her there, anyway.
posted by jonathanhughes at 8:36 AM on July 6, 2021 [1 favorite]

So I was just googling for pictures of toes swollen due to bloodclot and the google reminded me of the existence of covid toes. Is she vaccinated? She should maybe get tested at ER and even though covid toes seem to come later, after the virus has cleared, you might want to take precautions on arrival until she can get tested, especially if you are not fully vaccinated, too.
posted by If only I had a penguin... at 8:36 AM on July 6, 2021

I would go to whichever doctor you can see first among:

- podiatrist

- primary care / internal medicine with a geriatrics focus

- urgent care

- telemedicine


Primary care doctors are booked out a while for new patients where I am. I think a lot of them retired recently, and they've been booked for years. If you can find one with geriatrics focus, so much the better. However, back in March (I think), I set up a new patient appointment with a doctor - for August.

There's a chance that a specialist like a podiatrist will have less of a wait, and this is definitely a foot problem.

Urgent care - It's also worth researching to find a really good urgent care practice. Not only can they perhaps identify the problem with the foot, they sometimes will recommend specific doctors to see next. Maybe they can give you a referral so you can get in sooner.

- telemedicine -

I don't know a lot about this, but it's probably worth examining telemedicine options. Your Mom might like the convenience, privacy, and control of being in her own home. You can also take the opportunity to make sure she has all the technology she needs.

Telemedicine means, too, that she can see _any_ available doctor, not just the ones nearest her. She might be restricted to her own state, but it probably depends on the state. I was able to become a new patient at a specialty clinic in Illinois recently, even though I'm in North Carolina.

In researching telemedicine, you can look for doctors with videos that show them to be the kind of person your Mom usually likes (does she respect or loathe authoritative-sounding men? Gentle dweeby lady doctors? Etc. -- if there's a doctor she speaks fondly of, maybe you can find someone that looks like that person.). You can also show her the videos so she can choose someone that seems smart to her, or someone that she'd enjoy talking to.
posted by amtho at 8:42 AM on July 6, 2021 [1 favorite]

This is 100% just a gut reaction on my part - I would say that if she can't walk on it, it is serious enough to warrant either ER or urgent care.

Here's a yardstick from my own life if it helps you figure out whether to go "urgent care" or "ER" - when I had stepped on a particularly stubborn chip of broken glass and couldn't get it out of my foot despite 2 solid days of trying, I went to urgent care (it hurt and I knew something was up, but I could still walk if I had unusually soft socks and I limped a little). When I slipped and fell on the sidewalk and couldn't move my knee, I called 911 for the ER (it hurt way worse and I had lost the use of my knee). It may come down to just how the toes look to you and how mobile she is.
posted by EmpressCallipygos at 8:42 AM on July 6, 2021 [3 favorites]

If it were me, based on the information provided, I would start with Urgent Care; in my experience they are pretty quick to send you to the ER if they cannot deal with the issue. (And if they can deal with it, you will potentially save hundreds to thousands of dollars vs. an ER visit, depending on insurance rules.)
posted by Kadin2048 at 8:44 AM on July 6, 2021 [17 favorites]

Also - If she's a retired nurse, have you tried (probably you have) getting to look at this as a medical professional with someone to care for? I bet she'd be a lot more proactive about this if it were your foot.
posted by amtho at 8:47 AM on July 6, 2021 [2 favorites]

There's the ideal thing to be done, and then what you can actually get done with the cooperation of a fully autonomous adult who is perfectly within her rights to do nothing if that's what she chooses. This is not a child.

It sounds like she's not going to go to the ER on her own. She may go with you, but it is probably going to be much easier to get her to agree to go if an urgent care doctor suggests that.

So I vote for taking her to urgent care and going from there. I would also urge you to NOT look at her foot an panic. That will only make her much more resistant. Do not make a situation that is already at the limit of her tolerance more stressful. Calm and compassion.

Good luck to you both!
posted by DarlingBri at 8:54 AM on July 6, 2021 [2 favorites]

I'm an emergency physician.

for about a week she can barely walk on it and the front 3 toes are red and swollen like they have blood trapped under the surface.

Go to the emergency room. Now
posted by BadgerDoctor at 9:14 AM on July 6, 2021 [65 favorites]

If you go to Urgent Care, there's a very good chance they will send her on to the ER, so I don't think it will make a big difference which one you go to. But do it, this is a proper emergency, lots of very bad things could be causing this and she could lose her foot or die.
posted by mskyle at 9:30 AM on July 6, 2021 [1 favorite]

I, too, am an emergency doc. That sounds like a leg-threatening emergency to me, until proven otherwise. She should go to the ED now.
posted by killdevil at 9:38 AM on July 6, 2021 [48 favorites]

I'm from a family who hides things, and the fact that she told you on the phone means it's actually worrying her or else she would have continued to hide it. And if it's worrying a hider, then ER for sure.
posted by Ftsqg at 10:35 AM on July 6, 2021 [13 favorites]

Call the ER to see if there's a long wait. I've gotten mixed results from Urgent Care in my area; the one nearest me is pretty terrible, and decent care at other Urgent Care places. If she has to wait hours in an ER, it may reinforce the health care avoidance. Start now to make phone calls to get her a PCP, preferably a gerontologist or internist, but there's should be someone you can call.

Thanks for taking care of her; sounds challenging in this instance.
posted by theora55 at 10:42 AM on July 6, 2021

Can you pre-pay and send an Uber to her?
posted by Dashy at 10:44 AM on July 6, 2021

I cannot stress this more strongly: your mother needs immediate medical attention. This CANNOT wait.

Call 911. Get her an ambulance

Right fucking now
posted by BadgerDoctor at 11:48 AM on July 6, 2021 [29 favorites]

Can she be convinced to go without you or are you literally going to need to motivate her into the car when you're there? If this were someone near me I [as a vaxxed and unemployed person] would be willing to accompany them, maybe someone else who's in the same city can do that?
posted by needs more cowbell at 12:46 PM on July 6, 2021

This could be cellulitis, which can be very serious if left untreated.
posted by mani at 1:39 PM on July 6, 2021

2 ER docs have weighed in above - ER immediately. Call an ambulance for her, they will get her there even if she doesn't want to go.
posted by tristeza at 1:48 PM on July 6, 2021

Could be ER, or at least urgent care. It needs to be looked at ASAP. Could be foot trauma or even poor circulation, which, if untreated, can cause anything from gangrene (and loss of the toe(s)) to sepsis (blood "poisoning" / global infection).
posted by kschang at 1:51 PM on July 6, 2021

Call an ambulance for her, they will get her there even if she doesn't want to go.

This depends on the geographic area the mother is in; you can refuse an ambulance (even if you called it!) in my state. (Wife is a former EMT, she is NYEMT, etc.)
posted by joycehealy at 2:24 PM on July 6, 2021

This depends on the geographic area the mother is in; you can refuse an ambulance (even if you called it!) in my state. (Wife is a former EMT, she is NYEMT, etc.)

True! I should have made clear - they likely CAN convince her even if she doesn't want to...they're good at that. :)
posted by tristeza at 2:28 PM on July 6, 2021 [1 favorite]

Based on roughly 10 ER visits in the past 6 months with various relatives, right now in the U.S. health care system, ER is the only place you can get immediate diagnostic tests and treatments.

Which is exactly what your mother needs right now, this second.

Urgent care can do the same if you have a cough, sore throat, small cut, etc. You could get a prescription for your cold, flu, sore throat, skin rash, etc right away. That is the type of thing Urgent Care is for.

If you go to Urgent Care, they will almost certainly send you to the ER immediately.

If you go to a PCP, they can get the necessary tests, followups, specialist visits, treatments, etc, together over maybe the next 2-18 months. (Yes, months.)

Any PCP worth their salt would take one look at this and send you to the ER immediately. FWIW that is what my sister's PCP did for her--and her immediate condition was far, far less serious than your mother's.

In short: ER, now!

The sooner the better. It's the only place you can get immediate evaluation and treatment for a serious situation, which is what this is.
posted by flug at 2:33 PM on July 6, 2021

FYI, the PCP can order the same tests and specialist visits the ER can. But the PCP orders and ultrasound, it takes maybe 2-4 weeks to schedule, then 1-4 weeks to get a followup with the PCP, then you have your treatment plan based on that. Or xrays, CT scan, MRI, and such--all the same, except it might be 1-20 weeks out before you get that appointment, then a few more weeks to follow up. Specialists, the same, except it might be 2-10 months out before you can land your specialist appointment.

So, you need to those things and get them going now and follow up with them over time because that is how medium & long-term care happens in our system.

So I would definitely get the ball rolling on getting her set up with a PCP, maybe a diabetes specialist, wound specialists, and all the other things she might need, as soon as possible, too. But just be aware that if you are only staying a few days or a few weeks, you might not even be around for the first available appointment at a new PCP, which could be a week or two or 5 or 10 away.

If you CAN get in with a new PCP while you are there with her, that would be excellent. I would call around and try to do that if possible. If not, get everything all set up.

But that is in addition to getting her to the ER, pronto.

at the ER you'll have some essential treatment within an hour or so, essential diagnostics within a few hours, specialists consultations within a few hours to maybe a day, and so on. Its the ONLY way to get that kind of immediate treatment.

Again, this is based on roughly 10 actual ER visits in my part of the U.S. in the past half-year, plus uncountable doctor, lab, diagnostic, and specialist visits, for several different family members.
posted by flug at 2:46 PM on July 6, 2021

Another thing to consider (and I promise I'm done): Virtual visits are a real thing now and might be helpful for a doctor-averse person. Just for example, you could set up a virtual urgent care visit - around here we can usually get one within an hour.

If you show them this leg situation they will likely tell you "ER now!" just like we are.

But point is, this is something you can do in a few minutes from her own front room (and possibly even now before you're actually in her front room). Doctor-averse-person might be happier starting out this way and the comfort/convenience might help them get over some of the doctor aversion they have.

Certain PCP and specialist visits can be done this way, too. Honestly--from experience--for some things the virtual visits are better. And, they definitely save on multi-hour exhausting visits to the doctor's office so they can spend 5 minutes going over your lab results or whatever.

FYI this is how we got our doctor-averse mother to go to urgent care about a skin rash last week. Not sure it would ever have happened if we couldn't have gotten it going on her iPad at the kitchen table.
posted by flug at 2:57 PM on July 6, 2021 [1 favorite]

In a similar situation I sent my father to urgent care. It was the best thing ever.
They diagnosed him, set up a treatment plan, referred him to home health, cardiology, and his pcp, started him on the appropriate medications, etc. ]
100% would do it again.

Urgent care at a minimum. ER if your urgent care isn’t well integrated in her health care system.
posted by SLC Mom at 3:09 PM on July 6, 2021

I’d seek immediate medical attention as soon as possible. That probably means ER. But you might be able to get her a PCP sooner than you think. Can you ask her to snap a picture of her insurance card? Some companies automatically assign PCPs to members. Or if you call the company and request one they may be to help you. Call with your mother on the line so they can verify her identity and then have her authorize them to speak to you about the account, if possible.
posted by bq at 3:25 PM on July 6, 2021

Like, is there a neighbor she’s friendly with who can talk to and ask them to take her to the ER right now?
posted by bq at 3:25 PM on July 6, 2021

Oh, another thought. Does her insurance have a 24-hour nurse line? Perhaps, as a retired nurse herself, she would trust a fellow-nurse telling her to get to the ER right away (which is what I think would happen).
posted by praemunire at 3:42 PM on July 6, 2021

Response by poster: Thanks everyone, I appreciate all the advice. ER (I think her hospital has an urgent care/triage option in addition to ER) sounds like the way to go-- that's what I figured, but just wanted to make sure I'm on the right path. I'll be on a flight in a couple hours and be calling her about the ER before I go. If she doesn't go before I get there, she's going right as soon as we get in the door.

I agree whole heartedly with you-- it needs to happen, yes she should take her neighbors up on their offers of help, but she's been super stubborn and very averse to doing tech stuff unless I walk her through it. It's all been very hard; her husband (my dad) died of diabetes and stroke complications which started with a gangrenous foot and my sister died from a unexpected pulmonary embolism. Two very good reasons to not mess around with waiting. But it's been really hard to get her to understand that her health and especially this is serious.

Thanks again....
posted by actionpact at 1:31 AM on July 7, 2021 [10 favorites]

at the ER you'll have some essential treatment within an hour or so

It's frustrating reading all the glowing words in this threads about ER treatment. I have not had good experiences taking people (clients, family, friends) to the ER. I'm sure it depends on location, but in suburban MD where I live it is the norm to wait multiple hours to even be triaged, unless you come in by (hellaciously expensive) ambulance.

I accompanied my mother to the Frederick Health Hospital ER recently at the direction of her PCP, after a fall (she's 85!) and she wasn't given a bed for about 8 hours, and pain meds later than that. The waiting room was standing room only for much of our waiting time. Thankfully she was given a wheelchair to sit in at least. But sitting there with no pain meds, no food, no idea when she would be helped for hour upon hour, was not a healing experience.

My experience with urgent care is that you are seen much more quickly and that a referral from urgent care to the ER gets you seen much more quickly there too.
posted by Flock of Cynthiabirds at 2:51 AM on July 8, 2021 [3 favorites]

How are you and your mom doing now?
posted by insectosaurus at 2:25 PM on July 8, 2021 [4 favorites]

Response by poster: Update: we went to the ER and found out she has severe vascular disease from smoking and one of her arteries is blocked, which means that her circulation in her foot is very weak and the toes were necrotic. Took several hours in the ER but she’s in the hospital now awaiting surgery to fix the artery and then some part of her foot’s going to be amputated.

So, this is a good reminder to you if something seems off to you, please don’t wait days and days to get help. This probably wouldn’t have needed as much amputation if she’d gone earlier. Thank you all for your suggestions, she might have lost the whole foot if we waited like she wanted…
posted by actionpact at 8:17 AM on July 10, 2021 [10 favorites]

This sounds like a tough time for you both but I'm glad you got there and your mom got the medical care she needs.
posted by DarlingBri at 1:09 PM on July 10, 2021 [2 favorites]