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EMERGENCY ROOMS, URGENT CARE CENTERS, AND OUR OFFICE PART II

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.

Author: Dr. Jon Farber