Primary Care/Pediatrics VS the ER

[weddell]

I'm looking for people's opinions on when something is worth going to the ER vs seeing the pediatrician. It seems to me that our pediatrician's office does less and less and instead refers you to different places for things that seem like they should fall under the umbrella of "primary care." 

 

Today at school my 10 year old was playing on a wooden play structure and sat on a wooden bridge. The edges must have been damaged and when she sat, several long splinters went into her leg. The school nurse removed one but my daughter was feeling anxious and so the nurse didn't want to continue because she didn't want to make her more upset. The nurse said she thought that I could probably remove them at home, but that I might want a doctor to do it since it would probably hurt and they would make sure to get them all. The area on her leg was maybe 2 or 3 inches square and had maybe 5-10 splinters. I took her to the pediatrician's office and they wouldn't even see her (we had an appointment, that wasn't the problem). They let me talk to a nurse who said that splinters required an ER visit. She saw the area and how small it was. I told her straight out that going to the ER to remove 5 splinters was ridiculous. She then backtracked and said that I could take her to "immediate care" instead if I really wasn't willing. So I drove to immediate care which it turns out is a walk-in clinic in a family practice (same large healthcare system as the pediatrician). They saw her right away, spent 15 minutes pulling out splinters, and we went home with further instructions. 

 

Now it seems to me that a few minor splinters from wooden playground equipment really falls under the umbrella of primary care/ pediatrics and not the ER. If the whole side of her leg had been covered with them or they were metal or glass, I can totally see going to the ER, but that wasn't the case and the nurse and the doctor she spoke with knew this. It took another doctor just 15 minutes to deal with it. How long would we have sat in the ER? How much more would this have cost? This isn't the first time in recent memory where this same pediatrician's office has told me they don't do certain things and sent us somewhere else without even seeing the child in question, just a blanket statement "we won't see kids for that". While there are times I completely agree a specialist is necessary, for instance my kids definitely need to see an allergist, these instances are all for minor things that I remember seeing my regular doctor for as a child. This office seems like all they do anymore is well baby checks, strep throat tests, and pink eye. Has anyone else seen this trend? Do splinters really deserve a trip to the ER and I'm just out of touch? 

[ktgrok]

I'm guessing the issue is they must not do anything that requires anesthetic? Like numbing injections? Does seem odd...do pediatricians stitch things up anymore?

[gingersmom]

My old pediatrician would not see my daughter for splinter removal.

 

Thankfully the camp nurse was able to get them out.

[Terabith]

That's bizarre. I'm certain our pediatrician would do it.

[UCF612]

Seems like a pediatrician/pcp or urgent care to me. Definitely not ER IMO.

[UCF612]

I'm guessing the issue is they must not do anything that requires anesthetic? Like numbing injections? Does seem odd...do pediatricians stitch things up anymore?

My oldest got staples in his head at the pediatrician after he cut it open on playground equipment. I rank that the same as stitches.

[catz]

That is just plain stupid.  I'd switch peds in a heartbeat with that kind of runaround. 

[lauraw4321]

That makes no sense. You are right - that's crazy. Find a new ped.

[TechWife]

That's primary care/pediatrics. I'm really surprised the peds office didn't take care of it. ED is definitely overkill. 

[Valley Girl]

That's really odd. Ours has fished foreign objects from ears, dealt with sprains, and (gasp!) even done a minor procedure involving anesthetic and a scalpel. I'm another vote for finding a new pediatrician.

[Crimson Wife]

I almost always go to urgent care first if it's open. Sometimes they will send us to the ER but since it's part of the same system, they facilitate the transfer and we wind up with a shorter wait than if we had gone there directly.

[weddell]

That's really odd. Ours has fished foreign objects from ears, dealt with sprains, and (gasp!) even done a minor procedure involving anesthetic and a scalpel. I'm another vote for finding a new pediatrician.

 

One of the other times this same office sent us somewhere else was for a minor sprain. Again, they wouldn't even see the my DD, they automatically send every hurt wrist, ankle, etc. to the orthopedic clinic. That time I gave them the benefit of the doubt even though I really didn't think she needed an xray. This same child broke her finger later and it looked broken so I knew to take her to the orthopedic clinic without seeing the pediatrician, but I thought the sprained ankle was a little annoying. It's just this splinter thing was maybe the third time they sent us somewhere else...

 

And they didn't use any anesthetic to numb the area with the splinters. That was my initial thought on why they wouldn't do it at the pediatrician's office, but immediate care didn't either. And it did hurt, poor girl! I suppose the ER would have.

 

Thanks for making me feel like I'm not crazy with this.  

[Ottakee]

We had to go to ER before for splinter removal. My dd had a one in her foot. We tried urgent care as it was a Saturday but the wouldn't do it and said ER. ER doc got it all out in under 5 minutes. I agree it was something that primary care or urgent care should do.

[Ali in OR]

Sounds like primary care or urgent care to me. ER trips are way more expensive and I think they should be reserved for more serious issues.

[Excelsior! Academy]

Yes, the pediatrician should've done it!  Urgent care would be the next choice.  It is absurd they wanted you to go to the ER!  And we wonder why the waits are so long when there is a true emergency.   :rolleyes:

Edited May 20, 2016 by Excelsior! Academy

[gardenmom5]

the ped should be able to do that - unless they're really afraid of it taking up their time!

 

urgent care for most splinters seems over the top (I can think of a few scenarios).   but hey, if the ped wants to pay your medical bill for the ER . . . . seems a waste of their time and your money.

 

I'd be looking for a new ped/clinic.

[purplejackmama]

Well I am unable to comment on where I would go because all emergencies in our family happen at 2am and my kids prefer weekends and holidays ;)

 

But given your circumstances I would have gone exactly where you went and I would be as baffled as you are that splinters are an ER thing.

[Carrie12345]

My kids prefer to get sick and injured during non-business hours.  :glare:  So I can't really speak to the regular practice side.

 

A couple of months ago, ds9 needed stitches.  We called ahead to our brand new urgent care, which is within a brand new building of general and specialty practices, just 10 miles down the road, vs. 20ish for all the other UCs.  It was kind of exciting!  Dh brought him in, they took a look at ds,  said they shouldn't do it, and told them go to the ER another 15 miles away.

 

Fortunately, ds was calm and not gushing blood everywhere.

 

FWIW, this was a leg wound, not a delicate face stitching or anything.

[Laura Corin]

I'm pretty sure that the nurse at my doctor's practice would do that.

[Bluegoat]

I think that is bizarre.

 

Kids here don't normally go to a pediatrician, they go to the family GP, but I would expect the GP to deal with it.  In the clinic I go to it would be a toss up whether you would see your own doctor for a cisit like that or the duty doctor, but you would see someone.  The duty doctor is available for extended hours and Saturdays too.  We've been referred out a few times from our clinic - once when my dd had pneumonia so they sent her on to the children's hospital for x-rays, which was totally appropriate.  And one when my older dd needed her hand stitched -  it probably wasn't necessary but they have a policy of sending hands that need stitching to plastics which I understand.

 

In a very small practice here it might be more likely to be refered on (no duty doctor), or over in the other part of the city.  Now - the reason it is different in that part of the city is that doctors have historically not had good very coverage at clinics for emergencies,  same-day appointments, or off-hours. They are near the medical school and a few big regional hospitals and they've tended always to refer people there.  Which IMO sucks and even if I lived over there I would not be likely to switch to a practice there.

 

 

[JFSinIL]

I suspect they did not want to spend the time or have a nurse spend the time it might take to remove the splinters.  Gotta crank those appointments out and make bank. :-(

[TammyS]

That's nuts.  I would probably have pulled the splinters myself, but I guess there's something about these splinters that I'm not imagining.  I can't see why it should take anyone more skilled than a nurse. 

 

I would def dump the office and find somewhere else.

[Katy]

I think it's for insurance purposes- anything that requires piercing the skin is considered minor surgery.  If she got an infection like MRSA from the splinters it would be easy to file a lawsuit against the pediatrician, but more difficult against an ER.

 

Ridiculous to be sure, but that's the ridiculous world we live in these days.  If we raised the standards for medical malpractice to only apply to obvious criminal negligence you wouldn't see these types of rules.  The fact that this varies based on the state you live in is another sign the issue is the doctor's malpractice insurance.

[EmseB]

I don't know what is going on with ped's offices lately, but last time I took my DS in to check for strep the doctor said they didn't have rapid strep tests. "We used to do them, I don't know what happened."  So, they had to send out a culture to the lab which took 3 or 4 days.  In the mean time, she suggested antibiotics anyway because she saw the infection in his throat and we were about to go on a big trip/vacation, and then it turned out not to be strep.  She also mentioned they didn't have the flu swabs there either.

 

Granted, this was a government/Tricare clinic, but I was just thinking what a waste of an office visit, antibiotics, etc, etc.  Because they wouldn't stock a fairly cheap test for whatever reason.  She mentioned that if he "got worse" on off hours I could take him to urgent care or the ER and get the test done there.  Which I would not have to pay for, but would cost the government more $$$.  So wasteful.

[wapiti]

Things have definitely changed.  We've been going to a large pediatric practice for over 10 yrs.  They will still do stitches and certainly stitch removal, assuming it's a simple case.  But, I literally cannot *ask a question* (that becomes a "problem") or have some new problem discovered at a well checkup without getting charged a lot for it (like, >$200).  Right now I'm procrastinating on setting up the well checkups - last year I didn't even take four of my kids in for them; I only took the two who needed forms for school.

 

Ever since a combination family practice/urgent care opened up right down the street, we go there for possible broken bones, possible stitches, etc.  If needed they'll refer us out but they take care of the basics pretty well, cheaper than our large ped practice, and we can walk-in.  They have an x-ray machine there - so much easier than either the ped or the ER.

Edited May 20, 2016 by wapiti