The purpose of this study was to examine patients' and physicians' perceptions of the urgency of need for emergency medical care, and why patients come to the emergency department (ED). Survey instruments were utilized at EDs at an academic tertiary care center and a community hospital. Physicians' prospective assessment indicated that 65.8% (921 of 1,400) of the patients seen needed attention within 12 hours, whereas the patients' perception was that 86.5% (957 of 1,106) needed care within 12 hours. Patients' and physicians' retrospective responses were compared; in 19.5% (152 of 781) of cases patients rated urgency of their condition lower than the physician. These results indicate that patients and the physicians who treat them, despite the passage of a decade since a previous report of a similar study and a vastly different patient and physician population, have similar perceptions of the need for emergency care. Additionally, patients presented to EDs for a multitude of reasons; however, in strikingly different patient populations, a number of reasons are identified consistently.