Part two: Urgent Care Centers Versus Our Office

What if your child is ill, and you want him to be seen quickly, and you know he does not need an ER visit? Your choices are between us and an urgent care center.

We have been working hard to make our office more parent-friendly. Thus, all our locations have walk-in hours from 8-12 and 2-4 each day, if you want to just come in with an acute mild illness (e.g. coughs and colds, fever, mild injuries), and wait for the next available opening. We tend to process these quickly although there are times – for example, during flu season – when there can be back-ups. As always, we continue to offer sick appointments as well if you want to be more likely to have your child seen on time, or have a more complicated problem (e.g. headaches, ongoing abdominal pain). We also offer evening hours and weekend (Saturday and Sunday) appointments.

The undeniable advantage of going to an Urgent Care instead of us is that it is usually right near-by, with a short drive, and can be quicker than seeing us. What could be simpler than going in for a quick strep test to see if your child needs medicine?

The answer has to do with the quality of care you might receive. Most Urgent Care Centers are staffed by practitioners who have trained primarily in adult medicine. (There ae some exceptions to this. KidMed in Stafford uses providers with pediatric backgrounds, and the Inova Urgent Care locations in Manassas and Springfield do as well, at least for part of the day). They are less comfortable taking care of children, and as such often practice ‘defensive medicine’ to make sure they are not missing something, as they have less confidence in their clinical skills.

As an example, I will describe a very common scenario. You take your child to an Urgent Care for a sore throat. There, a rapid strep test is done (perhaps reasonable, but not all sore throats require testing, if the doctor can be pretty sure it is not strep).   Then because of a bad cough (which, by the way, makes strep much less likely), a chest-X-ray is ordered to see if there is pneumonia. Now, pneumonia which can only be seen on X-ray, and is not suspected on a physical examination, is almost always viral, and will not respond to antibiotics, so the x-ray, even if positive, should not change treatment. We therefore almost never order X-rays on patients we see in the office. When both of those come back negative at the Urgent Care, indicating a viral illness, an unnecessary antibiotic is often prescribed anyway, ‘just in case.’ Many times, the antibiotic is Zithromax, rather than the less expensive but otherwise identical generic azithromycin. I will also point out that, while azithromycin can be useful in adults, in pediatrics there are almost no common conditions for which it would be the first choice, even if an antibiotic were indicated.

Thus, if you do go to an Urgent Care, and they want to order an X-ray or blood test, I recommend you at least ask what they hope to find that would affect treatment. And, if they do order an antibiotic, ask them what they think they are treating. In our office, in the case described above, your child would be seen, diagnosed as having a virus without unnecessary testing, and sent home without an antibiotic but with information about what to do while you wait for your child to improve naturally on their own over the next few days.

Bottom line, although urgent care centers have their place, I advise that, when possible, you bring your child to our office to be seen instead. You will be seen by someone who has access to your child’s medical history and knows pediatrics. While it may not be quite as convenient as an urgent care center, I strongly believe that it is in your child’s best interests as well, and that is why I recommend it.

EMERGENCY ROOMS, URGENT CARE CENTERS, AND OUR OFFICE

There are different places you can take your child to for health care, and in this two-part article I will explore them in greater detail.

Part one: The ER

I will start with the ER first. Hopefully, your child will never need one. However, I understand that there is nothing as worrisome to a parent as having a sick or injured child, and the temptation to use one in these circumstances can be great. How do you decide whether or not your child needs an ER? I have a simple rule to help you decide:

IF YOU DON’T FEEL YOU NEED TO CALL 911, YOU DON’T NEED TO RUSH TO THE ER.

Of course, no rule is 100%, and you still need to use your judgment, but this is highly reliable. This does not mean your child can avoid going to the ER; what it means is that you have time to look into the question further before making a decision. To help you decide, I suggest that you call our office. We have triage nurses available 24/7 who work under the supervision of the doctors, and who are trained to answer these questions, with set protocols. A doctor from the practice is always available (again, 24/7) as back-up if they feel we are needed. If the recommendation, following talking with us, is to go to the ER, you can feel comfortable that that’s the way to go.

Another source of reliable information is our webpage, which has useful links on pediatric conditions. Lastly, for those of you who have smart phones (which seems to be everybody but me), the app Pediatric SymptomMD ($2.99) is a very reliable resource on pediatric care that is meant specifically for parents.

There is a surprisingly long list of things which do not usually require ER visits, even after discussion. This includes: fevers, even if high; lacerations which stop bleeding on their own; head injuries where a child is not unconscious, even if there is large swelling; finger and toe injuries even if they look broken; vomiting if not yellow-green, even with abdominal pain; and croup. Call us; if we feel you should take your child to the ER, we will tell you so, but otherwise we can make arrangements to be seen in our office, if needed, in a more efficient manner.

Why do we try to avoid the ER? For one thing, we feel that it should really be just for emergencies. Every patient who shows up in an ER who does not need to be there is potentially taking time away from someone who truly does have an emergency. A second factor, quite honestly, is the cost. If you have a plan with co-pays, you will pay significantly more for the ER visit than being seen elsewhere. And for those of you with high deductibles, the average cost of an ER visit starts at around $1000 and can go much higher.

Please visit next week to read part two: Urgent Care Centers Versus Our Office