I use the va clinic so there also is no ER. If I have a bad enough issue I go walk in. Either to the regular Dr for medical issues or the mental health clinic for mental issues. Usually they want you to go through telecast first but since the bus ride for me is 2 hours, I leave before telecast is open. But walk in n telecast are 2 other choices. Also I have gone to the pharmacy med issues n they have helped to work it out w the Drs. I don't know how your clinic works. I m not sure how the patient advocate works. That may also be another option.