Emergency department (ED) overcrowding by low-acuity patients is a recognized problem. There is little in the literature on why patients with minor problems and an established primary care physician (PCP) present to the ED. Two hundred forty low-acuity patients with a PCP were surveyed regarding their reasons for presenting at a University of Colorado ED. Inability to schedule a rapid clinic/office appointment, advice by PCP to utilize the ED, and high self-perceived severity of illness were the primary reasons for ED usage. Increased patient education about the range of conditions appropriate for care in the PCP office and more availability of office appointments could potentially decrease the ED usage by patients with low-acuity problems.