As a pediatrician, I want to share a cautionary tale with you. It's about a 3-year-old patient of mine we'll call Emma. She was recovering from strep throat and suddenly started feeling pretty miserable one Sunday evening. Emma was in so much pain that she refused to walk, so her mom examined her legs. Both of Emma's knees were swollen, and a rash was rapidly spreading all over her legs. The family rushed to a nearby urgent-care center. After doing several blood tests, the doctor, who was trained in adult medicine, was concerned that Emma might have a rare immune disorder called HSP (Henoch-Schonlein Purpura). He told her mother that the illness could lead to kidney failure, so Emma needed to be examined by her pediatrician.
I saw Emma (and her very worried mother) the next morning. With one quick look, I knew she didn't have HSP. She had an allergic reaction to amoxicillin--common, treatable, and rarely serious. Her rash did have an odd appearance, but I've seen it many times in my practice. After a few doses of medicine to treat the reaction (and a new antibiotic for her strep), she was running around again.
Although many children go to urgent-care centers and walk-in medical clinics and receive appropriate care, scenarios like Emma's do occur occasionally. She underwent unnecessary testing--and her mom got a few unnecessary gray hairs! Granted, my profession means I'm biased, but I believe that children get the best care from a health-care provider who has been trained to treat kids--preferably their own doctor.
The reality is, children get sick at inconvenient times and you won't always have the chance to see your own doc. When it's 8 p.m. and your preschooler is screaming that his ear hurts, you don't want to spend the night sitting in the local E.R. That urgent-care center around the corner looks pretty appealing, right?
Urgent-care centers, convenient-care clinics (which are located inside retail stores or pharmacy chains), and after-hours pediatric-care centers have found their niche in the evolving American health-care system. These facilities generate more than 160 million patient visits a year, according to the Urgent Care Association of America (UCAOA). They offer accommodating hours and central locations. Parents don't have to miss work to go to a doctor's appointment. And when people utilize these facilities for minor illnesses, they stay out of local hospital emergency departments--freeing up staff to take care of sicker patients and saving health-care costs.
While this growing trend has its benefits, there are also some limitations. Your child's primary-care office is better suited for long-term or chronic medical problems, says Nathan Newman, M.D., president of UCAOA. And Robert Block, M.D., past president of the American Academy of Pediatrics, adds: "Child-health issues can be vastly different from those of adults. Even if a problem seems minor, it can be the beginning of something more serious. So it's important to find a health-care provider who is appropriately trained and experienced in the care of children." This is what you should keep in mind before you're faced with an urgent medical need.
1. Know when your pediatrician's office is open. About 30 percent of primary-care pediatric practices--including mine--have evening and weekend hours, according to a 2012 national survey conducted by Physician's Computer Company, which creates software for pediatricians. If your doctor offers that option, it's undoubtedly the best place to go. First of all, your pediatrician's office has your child's chart. If you're lucky, your doctor will be working that night. And even if a different provider sees your child, your doc will be informed if any follow-up care is necessary. Using your child's "medical home" ensures that he gets treatment from a pediatric specialist and that he has seamless care.
2. Look for a facility that treats children. Ask your doctor; she can recommend the best after-hours options. You can also call locations directly for information or ask your insurer for in-network facilities near you. Opt for a pediatric urgent-care center (or, even better, a children's hospital), though these places may be hard to find. Pediatricians make up only about 1.5 percent of the urgent-care workforce, according to UCAOA. Nurse practitioners and physician assistants provide care at convenient-care clinics; doctors may only be available by phone. In urgent-care centers, you'll usually find family-practice or emergency-room specialists, but they may not necessarily have a lot of experience treating young children.
Be sure to ask what services are provided and whether there are any age restrictions. CVS's nationwide MinuteClinic walk-in clinics, for example, only treat children who are older than 18 months of age (24 months in Massachusetts).
3. Find out whether it offers on-site labs and X-rays. Not all urgent-care centers can perform blood or urine tests or X-rays on-site. Convenient-care clinics in drugstores do not perform X-rays and offer only a few screening tests, such as rapid strep or flu tests. Call or check their site.
4. Ask about the cost. Urgent care is not considered emergency care, and in most insurance plans the co-pay for urgent care is generally less than that of an emergency room (but more than primary care). Be sure to check with your insurer to find out your costs.
1. Call your doctor's after-hours line first. Make sure that going to a clinic won't be a waste of your time or money. What may seem serious--a fever that spikes, a painful ear infection--can usually be taken care of at the doctor's office in the next day or two. So don't hesitate to pick up the phone. You are not bothering us. Answering parents' calls is part of the job! Just be sure to use the after-hours line for immediate health concerns only, not for something like chronic diaper rash or to book an appointment for the next day.
2. Head to the nearest appropriate health-care facility. If your child has difficulty breathing; has sustained a major traumatic injury; seems confused or disoriented; is inconsolable; or can't be aroused, call 911 for immediate care and transport to a hospital. If your child might have a broken bone or need stitches, go to a location that can handle these situations.
Urgent-care centers can provide quality health care for minor health problems, but they shouldn't replace the relationship you have with your child's doctor, so follow up with your pediatrician. It's important that we're aware of any treatment you've had. Health issues can become more serious if there isn't one doctor who is able to see the big picture. For instance, your child's doctor can decide whether it's time to visit a specialist for recurring ear or strep throat infections. Or if your asthmatic child wheezes too frequently, your doc may prescribe a preventive medication that lowers the chance of having permanent lung damage.
Some walk-in clinics and urgent-care centers offer same-day physicals without an appointment if you forgot to have those forms signed and your child is starting camp or an after-school activity the next day. Still, as Nancy Gagliano, M.D., chief medical officer for CVS's MinuteClinic, says, "We do not consider these exams to be a replacement for a full annual physical and always recommend that parents make sure their child receives one with their primary-care provider." This is an opportunity to touch base with your child's doctor about all aspects of his health. For school-age kids, these exams may be the only time they see a health-care provider all year.
Originally published in the December 2013 issue of PARENTS magazine.
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