CHAPTER 45
Pediatric Urgent Care
Gary Gerlacher
from
A TEARFUL CAREGIVER WALKS INTO the clinic at 9:00 pm carrying a bleeding 5-year-old with a chin laceration, and you are the only provider available. Either your heart rate increases and you feel nauseated with dread or you are thinking about the most effective way to calm the caregiver and child and to repair the laceration with no more tears. If your plan is just to restrain the child and repair the laceration while the child screams, you are practicing medicine. If your plan is to engage the patient, to help the child talk about anything other than the injury, and to repair it while the child sits on the caregiver’s lap laughing, then you are practicing pediatric urgent care.
Like all of the practice of medicine, pediatric urgent care is an art form that requires the right combination of resources and skills to perform effectively. Infants cannot talk; toddlers do not cooperate; grade-school kids will not quietly sit still; and teenagers will not acknowledge your existence, because they already know everything. Every child is different, and you have no idea when you walk into the room if the child will be cooperative, disruptive, terrified, endearing, indifferent, or hyperactive. To succeed in pediatric urgent care you must be able to adapt your skills quickly to whatever state of chaos your patient presents.
The patient is only half of your problem. You also have to treat the caregivers. Unlike adult patients, who are usually able to understand and explain their problems, children rely on caregivers to provide a medical history. The fears and concerns of caregivers (Will my child have brain damage from a concussion?) are different from the fears of the child (Will I miss SpongeBob SquarePants tonight?). In addition to diagnosing and treating the child correctly with as little drama as possible, you must understand and address the fears and concerns of caregivers.
If it sounds like treating children is more complicated than treating adults in some ways, you are correct. So why bother? Moving beyond the obvious rewards of helping children feel better and caregivers sleep soundly, you have an enormous business opportunity in pediatric urgent care. Each of the 75 million children in the United States is a certified germ-dispersal unit, coughing, sneezing, nose-picking, spitting, and vomiting multiple times per year. School-age children tend to be sick several times per year, whereas most adults are sick only occasionally. To these millions, add visits for injuries, when courageous children decide to challenge the laws of gravity. When you include consultations for caregiver concerns about potential problems or questions, pediatric urgent care includes hundreds of millions of visits per year.