Six Reasons You May Want to Bring Your Child to the Pediatrician’s Office Instead of a Retail Based Clinic.

Written by Richard Lander MD

Why should I bring my child to the pediatrician when he/she is sick? It is so much easier to run over to the local retail-based clinic (RBC) at the pharmacy where there is lots of parking, I don’t need an appointment and while I’m there I can pick up tissues, milk and medicine. Right?

Here are six reasons why going to a RBC may not be in the best interest of your child’s health.

1 – Most RBCs are not Staffed with Board-Certified Pediatricians

Your child will probably be diagnosed and treated by a nurse practitioner or physician’s assistant. Imagine that you are concerned about your child and therefore a little distracted and forget to mention that your child has allergy to an antibiotic. This could have a bad outcome. If you are at your pediatrician’s office, that allergy information is kept in your child’s chart.

2 – You Can’t Call The RBC in the Middle of the Night

Now imagine that your child’s condition worsens at midnight. The RBC you visited earlier is now closed and so you can’t ask for further advice. On the other hand, had you called your doctor earlier and then required additional help later in the evening, you would be able to receive consistent medical advice because your doctor or a covering doctor is on call 24/7. The American Academy of Pediatrics has always stressed the importance of continuity of care. It’s what I want for my children; it’s what I want for your children.

3 – RBCs Have Age Restrictions

Many RBCs have an age below which they will not treat a patient. What will you do if two of your children are sick — take one to your doctor and the other to the RBC?

4 – RBCs Can’t Handle Complex Medical Issues?

Worse still, the RBC cannot deal with complex medical issues. If you visit the RBC with a problem that is beyond the scope of their training and knowledge, they will tell you to see your doctor or send you to the emergency room.

5 – RBC Provides No Continuity of Care

Let’s think about vaccines. Your child needs a flu vaccine as well as one or two other immunizations. Many of the RBCs are only prepared to give the flu vaccine. If you are receiving the flu vaccine at the RBC and all other immunizations at your pediatrician’s office, no one will complete your [child’s] vaccination record. Again this speaks to a lack of continuity of care. This fragmented record keeping could cause trouble in the future.

6 – An RBC’s Not Your Medical Home

Your pediatrician’s office should be your child’s medical home. Your pediatrician has cared for your child’s physical and mental well being since birth. At your pediatrician’s office you received vision and hearing screening, and we assessed your child’s fine and gross motor skills. Your pediatrician has checked for autism and ADHD, asked you questions relating to your child’s growth and development and if there was a concern, and addressed it. When a behavioral problem at school or home arose, it is your pediatrician who thought about the possible medical conditions that could cause these behavioral changes. Will your RBC help you with your child who is crying out for attention secondary to a new baby at home or to parental discord? Will your RBC talk to your teenager about depression, alcohol, drugs or tobacco use? If your child has a GI problem, a broken arm, a heart condition or a blood disorder, will your RBC recognize the problem and send you to an appropriate specialist? Would you want the recommendation of a competent specialist to come from your RBC or from your doctor who knows you and your family’s medical history?

Your pediatrician provides your children with vaccines after they have looked at the medical research. He/she does not give vaccines because a corporate entity (RBC) made the decision to do so. Your pediatrician went to medical school for four years and then did a pediatric residency for an additional three years and continues to both attend medical conferences and read the medical literature to make ensure that he/she remains current and ahead of the curve. One of the national RBC chains has the tag line “You’re sick, we’re quick.” Is that the kind of medicine your loved ones deserve?

 

Dr. Lander has been practicing pediatrics for 32 years in New Jersey and is the immediate past chairman of the American Academy of Pediatrics Section on Administration and Practice Management.  He says if he had to do it all over again he wouldn’t hesitate to be a pediatrician.

About these ads

8 thoughts on “Six Reasons You May Want to Bring Your Child to the Pediatrician’s Office Instead of a Retail Based Clinic.

  1. What if your pedi’s office just closed and your daughter has a 102 fever? I took mine to a minute clinic and did a rapid strep test and was able to start treating her 20hrs before she could have seen someone in our pedi’s office. I also took her just for a quick ear check when she got pink eye to make sure it wasn’t from an undiagnosed ear infection (again when the clinic was closed; pm on a weekend). I’d rather use my pedi, but love having a back up that is not the ER/urgent care in a pinch.

  2. Laura, you raise a very good question. The short answer, I think, is, “It depends.” I think you recognize that using your regular pediatrician is preferable, and I completely agree. Many families don’t agree– they want to use the RBC for “the easy stuff” and their pediatrician for “the hard stuff.” What these families often don’t understand is a) the hard stuff is even harder for us if we haven’t seen you for the easy stuff, and b) sometimes the hard stuff is masquerading as easy stuff.

    I think a good way to start would be to ask your pediatrician, “When you’re not available and my child is ill, what would you like me to do, and where should I seek care?” This comes up not just when pediatricians are temporally unavailable (holidays and nights) but also physically unavailable — when you’re vacationing at Disney World and your child has a terrible cough. I think there’s a lot of variety in what individual pediatricians would advise; some of this also depends on what we know about your child. Dr. Hackell has just posted a nice discussion of this topic too.

    You’ve also gotten me thinking about pediatricians who refuse to provide any kind of after-hours coverage for their patients, a pet peeve of mine. I’ll try to blog about that soon.
    Thanks for your comment!

  3. To Laura,

    I have a few comments. First of all, did the clinic actually do a strep test and was it positive, or were the antibiotics “just in case”? If it was positive, you should know that the 20 hour “head start” is of little value and in fact might make things worse. Strep will go away without treatment. All treatment does for the illness is shorten its course by a day or two. On the down side, evidence has shown that if Strep throat is treated very early in the course, the recurrence risk (getting strep again shortly after stopping the medicine) is greatly increased. Being mildly ill for a day lets your body have a chance to crank up its immune response on its own. Even if you got the head start, your child should not have gone to school the next day. If you got to the pedi early in the morning the next day, your child would have gotten back to school at the same time. As to the ear infection issue, I cannot tell you how many ER/Urgent Care/Retail clinic “ear infections” that did not exist, but were given antibiotics anyhow. Believe me, we are not just trying to get your business, there is a real issue of quality here as well.

  4. Thank you to Drs. Lander, Lessin and Berman for tactfully approaching this fery frustrating subject. The quality of care at our local RBS’s is horrible beyond belief. Unfortunately, most patients don’t understand how poor the care they received was but come 9 am, I am expected to fix the complications of the RBC’s poor management.

  5. Dr Lander, I fear RBC’s are here to stay. I am very chagrined to admit I just took my child to one for the first time. I am a big believer that you get what you pay for and I fully understand the importance of continuity of care. I drive an hour to take my kids to see their pediatric ophthalmologist because she has seen them for 10 years and that is worth more than a convenient local peds ophthalmologist.

    BUT, sometimes things just get out of hand. I am a single mom of three kids. Life is full though fun, and I admit readily that sometimes I don’t have all my ducks in a row. I have to sleep at some point, don’t I? I quit my last board certified pediatrician when I found out that the office staff had singled me out for special treatment. They had a note on my file to NEVER fax my referrals. I had to drive over to pick them up. They didn’t know that just getting my kids to the opthalmologist was a major victory. In 10 years of each of my 3 kids seeing that specialist (among others) 4-6 times a year, I have missed an appointment only once. But there were some times (not many, 2 or 3?) that I forgot to get the referral 48 hours in advance and I asked them to please fax it over. Nope, their rule was 48 hours and they didn’t want to deviate from that even for a harried single mom with no support system. Actually, I’m not telling the truth. I didn’t quit the Pediatrician over that. I waited until he spoke unkindly to my daughter. But, the fact that he couldn’t cut me slack when I so desperately needed slack (I have no family where I live and my exhusband provided no support whatsoever and I struggled for many years just to not get fired because my kids, being kids, were sick for more than I had days off) was the major reason I quit him.

    I am totally digressing here. The truth is that my current ped has a great practice with 3 docs. I like her a lot. Efficient, kind and convenient. But only has late office hours once a week. It is not easy to get a Sat appt and with three kids my schedule is unbelievably tight. So when I realized with one week to spare that I didn’t have a sports physical for my son, I called the ped. The only opening was in three weeks. I slunk over to the RBC and paid cash for the sports physical. I likely won’t admit this to my ped when I take my son for his physical (he is 16) but I was grateful he didn’t miss a game because mom was too busy to see straight.

  6. Pingback: For Pediatricians, Giving Vaccines Is An Ethical Dilemma « Survivor: Pediatrics

  7. Pingback: Top 10 Pediatric Post of 2011 « Survivor: Pediatrics

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s