Part 2 Kids’ Healthcare: 3 Types of Physician Visits
Understanding the 3 types of physician visits your child may need
Physician visits are an important part of your child’s healthcare management. Most mothers have already chosen a pediatrician before the baby is even born…am I right? Yes, I did, too.
The pediatrician, our child’s primary care doctor, is meant to serve as our rock, our stability …our person, if you will. These physician visits are our first line of defense if we are unable to treat our child’s problem at home. Since you remember how much research went into choosing your pediatrician, you definitely want to utilize her!
Pediatricians are meant to be with us while our kids grow, and they are the guardians of our children’s medical records which determine if another doctor should be included in the care of our children. They should be your first choice for treatment if your child needs to see a medical professional.
Traditionally, emergency rooms and urgent care centers have been the second level of care for our children when illnesses occur while the pediatrician’s office is closed. These types of problems are urgent in nature and cannot wait to be seen during office hours. After being seen by these urgent and emergency care providers, patients are instructed to follow up with their pediatrician to insure the problem is resolving or to determine if another course of treatment is needed. These urgent physician visits are meant to be rare visits between the normal care provided by pediatricians.
Specialty doctors (like me!) are available for your child if a third level of care is needed. We review the history of your child’s problem as well as all the treatment options that have been used and then determine if surgery or a procedure or more aggressive medical management is needed.
These three levels of escalating physician visits, medical care and treatment have worked well for years and years. Until recently.
There is now an epidemic of immediate care centers which are opening across the country. The centers were initially intended to be used for occasional after hour visits for problems which are not as severe as urgent care or emergency room visits; however, they have gained increasing popularity for treating problems which could wait to be seen during pediatrician office hours. Because these centers offer a low fee schedule that can cost less than standard co-pays and hours that can be planned after school, work or weekends, many parents have started to consider these immediate care centers as a normal part of their children’s health care management team.
For an increasing number of children, these urgent care centers have have become replacements for pediatricians. One problem with this situation is that many of these immediate care centers are staffed only by Nurse Practitioners who do an excellent job treating straightforward problems like ear infections or strep throat. But these providers are often not prepared to evaluate many situations where a previous medical history is helpful. Chronic headaches and stomach pain are not easily assessed on an urgent care basis in this setting.
Other centers are well staffed by physicians who are ready to treat more complex problems, but these physician visits are not the same as a visit to your pediatrician because there is no ability to review your child’s history and determine the next course of action. These immediate care physician visits are meant to simply treat the acute problem. It is not their job to determine when more advanced evaluations are needed since patients are still expected to follow up with pediatricians for long term solutions. Many parents have stopped taking the step to make an appointment with their pediatrician to review what happened while their office was closed.
This is where the problem occurs. Mothers become frustrated about repeated illnesses and want to escalate their child’s care to a specialist; however, the pediatrician does not know the illnesses have been severe or frequent. As a primary care doctor managing recurrent illnesses, a pediatrician might have done more than simply use antibiotics, which is the appropriate treatment by the immediate care physicians. Because of a possible delay in starting more aggressive treatments or a specialist referral, there exists a greater potential for complications when recurrent immediate care visits are substituted for consistent pediatrician visits.
When patients come to my office, I often need more information than parents can provide me when they frequently visit immediate care centers. My ability to obtain accurate histories and make an assessment about previous treatments have become difficult in these situations due to 5 reasons:
- Your child has seen by different doctors at the same facility and no consistent comparison is possible,
- Your child is seen at a variety of centers by a variety of physicians.
- Your child is taken to each center by different adults who provide different amounts of the medical history because there is no chart for the doctor/nurse to review.
- The discharge paperwork provided to the you from the immediate care center has a been lost and there is no other record of what happened during the visit.
- Your child was not taken to see the pediatrician the following week to discuss what happened or to make a plan of action to prevent future recurrences.
At this point, once parents come to my office, they are ready to proceed with surgery or more aggressive care and often do not understand that specialists need to insure that more conservative measures have been taken. This is where reviewing the pediatrician records is invaluable.
Because of the convenient hours and lower costs, I absolutely understand why these immediate care center visits are increasing. However, I believe it is important for parents to understand that these immediate care physician visits also bring an additional responsibility for personally managing and organizing their child’s healthcare. Because the pediatrician has frequently been taken out of the loop and no longer is the overall organizer of their child’s care, parents using immediate care physician visits need to take on this duty.
Part 3 of the Kids Healthcare series will deal with expectations parents should have when their child has been referred to a specialty physician. Parents assume a referral means a specific course of action is going to happen. The specialist visit is often not exactly what you think it is going to be!