Let me preface this post by saying that I have spent the last few weeks working in the pediatric emergency room–and I love it. It’s a well-equipped facility with a team of highly qualified people dedicated to providing excellent care to kids. But it’s not always the most appropriate place for your sick child–here’s why:
- The ER doctor doesn’t know your child. The trust that develops over time between a doctor and a patient (or family) is absent. It is also extremely helpful to have seen a sick child when they were healthy, to know how far from their baseline they are.
- Your child doesn’t know the ER doctor. Sick kids are not happy kids, and it’s hard to do a physical exam on a screaming 2-year-old. A familiar face causes less distress, and allows the doctor to do a better evaluation.
- “Emergency” does not mean that you’ll be seen soon. The ER team takes care of the sickest patients first. If your child has a minor illness and a severely ill or injured child rolls in, you’ll be waiting a while.
- It’s expensive. Really expensive. It costs about $500 more to evaluate a minor illness in the ER than it does in an office setting–and that’s without any tests.
- Your child will probably have tests. This means needle sticks, radiation exposure, and increased cost. Often, your pediatrician could do a thorough physical exam and schedule a follow-up the next day. But the ER gets one shot, and they can’t afford to miss something, so they tend to over-order imaging and labs. I’m guilty, too.
- The ER’s job is to figure out what your child doesn’t have. They are not tasked with figuring out exactly what is going on and solving every problem; the focus is on ruling out life-threatening conditions and deciding which patients need to be in the hospital. This often frustrates parents who come in wanting answers.
- There are sick kids there. This week, we have been seeing 20+ cases of vomiting/diarrhea per day. In the fall, it’s RSV. In the winter, it’s flu. We do our best to keep things from spreading, but viruses haven’t survived this long by being bad at what they do. If your kid wasn’t sick when she went in, she may be soon.
- If the beds are full, really sick kids can’t be seen. This is more altruistic, like vaccinating your child so nobody else gets polio–but it’s real. Every ER has a limited number of beds (we have 16), and when they’re full, they’re full. If they’re full of relatively healthy kids, the really sick ones sit in the waiting room until a bed opens up.