When my daughter injured her elbow after hours, I learned the limits of these timesaving medical facilities.
It was a snowy Sunday evening. I was prepping dinner, and my daughter was practicing her hip-hop dance moves. All of a sudden I heard her scream. I rushed into the living room. She was panicked, tears starting to flow. She had tried an inversion move, in which all of her weight was placed on her elbows. Then she heard something snap, and felt excruciating pain.
My wife and I suspected that our then-10-year-old might be overreacting and agreed it was most likely a sprain or strain. But we couldn't take any chances. I trudged eight blocks with Isabella in the slush to our nearby urgent-care center. It seemed like the right move: This facility is manned by ER doctors and the wait is generally 15 minutes or less. Plus, our doctor's office was closed. I didn't see the purpose of speaking to a nurse affiliated with the practice to diagnose the injury.
I'm hardly alone in turning to urgent care. There are around 9,500 such walk-in centers in the U.S., and they account for more than 160 million patient visits per year.
The center had an X-ray machine on site, and soon a doctor delivered the bad news: Isabella's elbow was fractured and would need a cast. I was relieved we'd made the trip. But not for long: The facility lacked the means to apply a cast. We would have to head to the hospital. Back out into the storm we went to flag a cab, which skidded its way to the closest ER, which fortunately had a dedicated children's section. This time we waited, and waited. Isabella watched Finding Nemo on a screen, trying to distract herself from the pain. Finally a doctor looked at the X-rays and saw . . . nothing. Technicians took another set. They were inconclusive. If there was a fracture, the doctor explained, it was in her growth plate area, which the X-ray might not be able to pick up. Several physicians conferred about what to do. Finally, they came to a consensus: No cast for now; follow up with an orthopedist.
That wasn't the final word on the matter. The pediatric orthopedist, who took yet one more X-ray, decided that given my daughter's obvious discomfort, she would benefit from having the arm (broken or not) immobilized. Isabella chose a pink cast, had classmates and friends sign it, and healed beautifully. She was back to her four-times-a-week dance routine in a couple of weeks.
The experience, though, changed my perspective. Up till that point, I had viewed urgent care as a convenient after-hours option for illnesses and ailments. When we came home from work to a sick child, it was the only place to go to get an immediate diagnosis. An evening visit also eliminated the need to dash home from work the next day to see her pediatrician.
But now I'm not so sure the tradeoff is worthwhile. Most urgent-care doctors don't have experience treating children (only 1.5 percent are pediatricians). I remember at least one time when my daughter's virus was misdiagnosed as an ear infection, resulting in an unnecessary course of antibiotics. In the case of her elbow, we could have saved a couple of hours by skipping this intermediate step and going straight to the ER (though I still don't regret not calling the doctor's office first).
Urgent-care centers still have their place, of course. When we couldn't coordinate my son's school schedule to arrange an influenza vaccine at his pediatrician's office, he and I walked into the very same center on a Sunday and got it done. I wouldn't hesitate to take either of my kids there for a strep test, either.
Still, when I felt sick one evening a few weeks ago, I didn't even think about getting examined there. Instead, I saw my doctor first thing the next morning. She quickly diagnosed my illness as H1N1 flu, tested me, and, within hours, prescribed Tamiflu—which no doubt shortened my suffering by a few days. Would I have gotten as thorough and precise care at an urgent-care center? Perhaps. But my primary-care physician knows me best. She's my go-to—not a doctor I've never seen before. The same applies to our kids: Their pediatricians know them best and need to be the first line of defense. And if an injury or illness is serious enough that it can't wait, I'll probably choose the pediatric ER next time.
David Sparrow is a senior editor at Parents and a dad of two. He is currently working on a ballroom dancing performance choreographed by his daughter but can't keep up.