Ask Dr. Mike: Should I Go to the ER or Tough It Out at Home?

Happy New Year, Dr. Mike! And speaking of the new year, the super flu and “mystery virus” have gotten 2026 off to a miserable start, raising a question: How bad should things get before you head to the ER? Not just with the flu but with other severe symptoms?
Many people use the emergency room as a primary-care practice. Wrong! The ER is designed for serious issues that can’t be handled as an outpatient in a primary-care setting. But a lot of people don’t have a healthcare provider, so they just go to the ER to take care of their problems. And ERs are overrun as it is. That’s why there’s a lot of urgent-care facilities out there.

For many of my patients, I’m the urgent care! A great New Year’s resolution would be to find a primary care provider who will be your guide and advocate. You can’t navigate health issues on your own — and if you don’t have your health, you don’t have anything.

Got it. But what if you’re having, say, chest pain? How do you know if it’s a heart attack or just indigestion or anxiety?
That’s a tricky question! For instance, a woman who has coronary disease may have heart-attack symptoms that don’t “fit” with symptoms we usually associate with a heart attack, like the “Levine sign” — someone clutching their fist over their chest — and pain down the left arm. For women, a heart attack might feel like fatigue; shoulder, neck, or jaw pain; sweating; or shortness of breath.

Also, we just came off the holidays, when people tend to drink more than usual and then eat salt-laden foods to kind of sop up the alcohol. This can lead to atrial fibrillation, where the top of the heart doesn’t pump properly. It can make you feel fatigued and even lead to a stroke, but you might not necessarily know you’re experiencing it. We sometimes refer to this condition as “holiday heart” but the risk obviously exists with increased alcohol consumption at any time, not just around the holidays.

Whoa! That’s scary. I can imagine people attribute their fatigue to alcohol — a depressant — when it could be caused by something more serious. Are there other symptoms to look out for?
If you feel your pulse, and it’s irregular or seems like it’s skipping beats, that might be a warning sign you’re not just tired from drinking. An Apple watch, if you have one, might also be helpful in a moment like that because it can alert you if something is off with your metrics or metabolics.

The bottom line, though, is this: If you’re experiencing chest pain, or heaviness or pressure in your chest, if you feel lightheaded or have passed out – go to the ER. Same with breathing problems, especially now that we’re in the thick of flu season. If you’re suddenly short of breath or feel winded, go to the ER, where an EKG or chest X-ray can get to the bottom of the issue.

You mentioned stroke earlier. A few years ago, I thought I was having one — I had the most intense headache of my life …
Stop right there! That phrase “the most intense headache of my life” buys you a stamp in the emergency room. If I was your doctor and you had called me saying what you just did, I would’ve told you to get help immediately, because it could be a brain bleed.

I did! Luckily, it wasn’t a stroke, but a complex migraine. Still, stroke-like symptoms aren’t something to mess around with. What other ones should people know about?
For a stroke, it’s not always the cause of a sudden, severe headache, though that’s a major warning sign. A person can also experience an acute onset of numbness — especially of the face — and vision loss, or like a shade is being pulled down over your eyes. There’s also difficulty speaking, feeling disoriented or confused, or experiencing an altered mental status. All of those are reasons to go to the emergency room.

Another thing to look out for: If you’re traveling (and sitting) for more than four hours, you’re at risk of developing a blood clot in your leg, called a deep vein thrombosis, which could travel to your lungs or brain and kill you. Warning signs include leg swelling and shortness of breath.

Is there a common thread here: the sudden onset of symptoms or changes to your health? Is that the “tell” for deciding when to go to the ER?
Not always, because symptoms can be subtle and happen over time. For example, a person might be in congestive heart failure and not feeling well for the past month, but then drinking at a holiday party puts them over the edge.

Disease can present in many different ways and it can act in a stealthy way — a great masquerader. Even young, healthy-appearing people can become unwell, even though we all say Gosh darnit, look how good they look! This especially true for women, who have been historically under-diagnosed with things like heart disease because they weren’t often included in the literature back in the day, or their symptoms were chalked up to stress and weren’t taken seriously. Well guess what? The cemetery is full of people who they thought just had stress.

What other situations require an ER visit?
For me, the threshold should be very low when it comes to abdominal pain. It could be something serious, like appendicitis, ischemic bowel — where the intestines aren’t getting enough blood flow — a gastric ulcer, or diverticulitis, which is an infection in the bowel that could lead to sepsis if not treated. Get to the ER!

But how do I know I’m not just gassy or have an upset stomach from dinner?
I tell my patients, “You know your body better than anybody.” If there’s concern, then it might be worth getting checked out. At the same time, I live by the quote “He or she who treats themselves, treats a fool.” Sometimes you may think you have an idea of what’s going on, thanks to Dr. Google. But you should call your actual doctor who knows your history. If you call and say, “I have abdominal pain,” and you have a history of constipation, well that’s something to consider. But if you have worsening abdominal pain, that could be a more serious issue.

I’m thinking about fevers. At what point do they call for an ER visit?
Well, it depends on what’s associated with the fever. If you don’t have accompanying symptoms and you’re able to manage your fever with medicine, then you could probably stay home — but still call your doctor! A fever of 103 or higher warrants medical care. If your temperature is 101 and you’re also short of breath, get medical attention immediately. Same thing goes for pain, swelling, or confusion. Stiff neck with a fever, or a rash with a fever? Go to the ER. That could be meningitis.

The bottom line is: Why would you take a chance with your health? The Grim Reaper will grab you in the ass when you least expect it!

(Ed. Note: Many health organizations recognize that a temperature of 103 degrees or higher — or a fever that continues for 48 hours without improvement — necessitates medical care.)

This interview has been edited for length and clarity.