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Cold and Flu Season is Upon Us!
Every year at this time, I think about how our kids are managed when they become sick. Not only what we do to treat symptoms, but how, when, and where patients get medical advice and care. During cold and flu season kids get sick. A lot.
We are a busy society. We want things done now. Quickly. Cheaply. Correctly. Resolution so we can get back to life.
Illness doesn't work that way.
Most childhood illnesses are viruses and they take a few weeks to resolve. There's no magic medicine that will make it better.
Please don't ask for an antibiotic to prevent the runny nose from developing into a cough or ear infection.
Don't ask for an antibiotic because your child has had a fever for 3 days and you need to go back to work.
Don't ask for an antibiotic because your teen has a big test or tournament coming up and has an awful cough.
Antibiotics simply don't work for viruses. They also carry risks, which are not worth taking when the antibiotic isn't needed in the first place.
Urgent cares are popular because they're convenient.
Convenient isn't always the best choice. Many times kids go to an urgent care after hours for issues that could wait and be managed during normal business hours. I know some of this is due to parents trying to avoid missing work or kids missing school, but is this needed?
Can it hurt?
Extra tests = Extra costs
Some kids will get unnecessary tests, x-rays, and treatments at urgent cares and emergency rooms that don't have a reliable means of follow up. They attempt to decrease risk often by erring with over treating.
The primary care office does have the ability to follow up with you in the near future, so we don't have to over treat.
No history
Urgent cares outside of your primary care office don't have a child's history available.
They might choose an inappropriate antibiotic due to allergy or recent use (making that antibiotic more likely less effective).
It's easy to fail to recognize if your child doesn't have certain immunizations or if they do have a chronic condition, therefore leaving your child open to illnesses not expected at their age.
We know that parents can and should tell all providers these things, but the new patient information sheets in my office are often erroneous when compared to the transferred records from the previous physician. Parents don't think about the wheezing history or the surgery 5 years ago every visit.
It's so important to have old records!
Records in one place
Receiving care at multiple locations makes it difficult for the medical home to keep track of how often your child is sick.
Is it time for further evaluation of immune issues?
When should you consider ear tubes or a tonsillectomy?
If we don't have proper documentation, these issues might have a delay of recognition.
Not all locations are good with kids
Urgent cares and ERs are not always designed for kids.
I'm not talking about cute pictures or smaller exam tables.
I'm talking about the experience of the provider. If they are trained mostly to treat adults, they might be less comfortable with kids.
They might order extra labs or x-rays that a pediatric trained physician would not feel are necessary.
This increases cost as well as risk to your child.
Drug choice and dosing can be complicated for clinicians not familiar with pediatric care.
We have been fortunate in my area to have many urgent cares available after hours that are designed specifically for kids, which does help. But this is sometimes for convenience, not for the best medical care.
Cost
As previously mentioned, cost is a factor.
I hate to bring money into the equation when it comes to the health of your child, but it is important, especially with the increasing rates of high deductible health insurance - you will feel the burden of cost.
Healthcare spending is spiraling out of control.
Urgent cares and ERs usually charge more.
This cost is increasingly being passed on to consumers. Your copay is probably higher outside the medical home. The percentage of the visit you must pay is often higher. If you pay out of pocket until your deductible is met, this can be a substantial difference in cost. (Not to mention they tend to order more tests and treatments, each with additional costs.)
What about the walk in clinic at your primary care office?
Many pediatric offices offer walk in urgent care as a convenience for parents who are worried about their acutely ill child.
If your doctor offers this, the care given is within the medical home, which allows access to your child's chart. All treatments are within your child's medical record so it is complete.
Staff follow the same protocols and treatment plans as scheduled patients, so your child will be managed with the protocols the group has agreed upon. Essentially primary care pediatricians have a high standard of care and want your child to receive that great care in the medical home as often as possible.
Telehealth
There are more and more telehealth options offered by insurance companies and physicians. This is a new area that has exciting potentials, but I'm concerned about inappropriate treatments. It can be a great tool to follow up on ongoing issues, but is not appropriate for many routine earaches, sore throats, and other issues that require an exam and/or testing.
I know it's tempting to call in to get a prescription for a presumed ear infection or Strep throat, but think about how those diagnoses are made and remember that overuse of antibiotics increases risks to your child.
So what kinds of issues are appropriate for various types of visits?
(Note: I can't list every medical problem, parental decisions must be made for individual situations. For a great review of how to determine if it's an emergency, see Reliable keys to identify a medical emergency from Dr. Oglesby at Watercress Words.)
After hours (urgent care or ER- preferably one for children):
Difficulty breathing (not just noisy congestion or cough but increased work of breathing)
Dehydration
Injury (including but not limited to bleeding that won't stop, a wound that gapes open, obvious or suspected broken bone)
Pain that is not controlled with over the counter medicines
Severe abdominal pain
Fever >100.4 rectally if under 3 months of age or underimmunized. (There is no magic temperature we "worry more" if an older child is vaccinated.)
Walk in clinic (or appointment) at your primary care provider's office:
Being sick isn't fun, but sometimes it just takes time to get better while using at home treatments. Use the healthcare system wisely to get the best care.
Fever
Earache
Fussiness
Cough
Sore throat
Vomiting and/or diarrhea
Any new illness
Issues better addressed with an Appointment in the Medical Home:
Follow up of any issue (ear infection, asthma, constipation) unless suddenly worse, then see above
Chronic (long term) concerns (growth, constipation, acne, headaches)
Behavioral issues or concerns
Well visits and sports physicals (insurance counts these as the same, and limits to once per year so plan accordingly)
Immunizations - ideally done at medical home so records remain complete
telehealth
If your primary doctor (or specialist) uses telemedicine as part of follow up care this can be a great use of telehealth.
Be careful of "free" or inexpensive telehealth options from other groups, including those from your insurance company. A quick and easy fix isn't necessarily a safe, effective, or needed treatment.
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