Keeping Your Kids Out of the Emergency Room by Christopher Johnson (ereader for textbooks .txt) 📕

Keeping Your Kids Out of the Emergency Room: A Guide to Childhood Injuries and Illnesses

By Christopher M. Johnson, M.D.

       Last year America’s 76 million children made 27 million visits to emergency departments. That is around one visit for every three children. Of course some children accounted for more than a single visit. Even so, the fact that a third of all our children going to the emergency department each year is a sobering statistic. Was your child one of them? If so, you probably know the difficulty in deciding if and when it is time to take your child there. Sometimes it is easy to know when to make the trip--an obviously serious injury, for example--but often it is very hard indeed to decide. This is especially so for parents of small infants, who account for a large proportion of children visiting the emergency department. Parents appropriately tend to err on the side of prudence; they bring their child in when they are unsure if the problem can wait or not. Usually this means deciding if their child’s problem can wait until morning, because three-quarters of children’s trips to the emergency department happen during the evening or nighttime.

            If you have ever visited an emergency department with your child, you probably noticed that, whether big or small, emergency departments are not set up for efficiency from a parent’s perspective. Rather, they are designed to be efficient from a doctor’s perspective and that of a critically ill or severely injured person. They are set up to be ready for anything on a moment’s notice. Like a fire department, an emergency department’s staffing and equipment arrangements need to be appropriate for a wide variety of worst case scenarios. Luckily, very, very few of the millions of children who come to the emergency department need these things. But the facility needs to be ready, just in case. This need inevitably builds an enormous inefficiency into the system from the overkill of being always prepared for such rare situations.

Many emergency departments also operate walk-in clinics for children, often adjacent to the full department. These, too, are often cumbersome, inefficient places to get your child needed care. For one thing, since your child’s regular doctor is not there, they do not know her. For another, walk-in clinics are also expensive to run--not so expensive as a fully equipped emergency department, but still quite costly. Yet another reason to avoid these facilities is this: if your insurance coverage has an out-of-pocket co-pay, as most do, it will probably cost you more than an equivalent visit to a doctor’s office. Why is that? The main reason is, although they might have portions of her previous medical record to consult, really these new doctors do not know your child at all. So they are much more inclined to order tests your regular doctor would not need. Of course if you do not have health insurance, your bill for going to an emergency department or walk-in clinic will be very much higher than it would have been for getting the same care at a visit to a doctor’s office.

            The fact that emergency departments are structured this way can be an enormous frustration for parents whose child is not critically, or even seriously ill. It is just hard for parents to know which problems should be seen right away, which can wait for later, and which probably do not need to be seen by a doctor at all. During my years working in the emergency department I often found that what parents really needed was not so much medical care for their child as it was simply information; had they already known what I told them during my evaluation of their child, they often could have avoided the emergency department visit altogether, or at least put off their midnight trek until the next day.

            This book will give you specific information about the ailments that most commonly lead parents to consider bringing their child to the emergency department or after-hours clinic. The goal is to give you, the parent, insight into how we doctors look at things, how we decide what is serious and what is not. It will also describe for you what care you should expect to receive when you bring your child there, as well when you should consider insisting on more than is offered to you.

            This book is not a substitute for a doctor’s evaluation, and it is certainly not an invitation to practice medicine on your children. Nothing can replace what a doctor does.  But over the decades I have practiced emergency pediatrics, I have found that nearly all parents, when given specific information about how doctors evaluate children in the emergency department, make excellent decisions about what their child needs. After all, no one knows a child as well as his or her parents.

DR. CHRISTOPHER JOHNSON has practiced intensive care and emergency pediatrics for over 30 years. He is former Director of the Pediatric Critical Care Service at the Mayo Clinic and Professor of Pediatrics at Mayo Medical School. He is the author of multiple papers in the medical literature, as well as award-winning medical books for general readers.

To learn more, please visit: http://www.chrisjohnsonmd.com

Publication Date: 01-18-2014

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