ER or Urgent Care? Not Always an Easy Decision

It’s One Thing to Know When We’re Lucky
Honestly, I consider myself one of the more paranoid Moms on the planet. When you work in health communications, you pick up quite a bit. I know just enough to make some doctors stop and chat, and some run for the hills while their nurse finishes up our visit. There have been a few close calls over the years – croup in the middle of the night when my kids were little, that time my daredevil toddler daughter flipped off my lap and dislocated her elbow. No one in the ER questioned the croup. My little gymnast, however, popped that arm back into place just as I got her out of her car seat in the ER parking garage, and waltzed right in looking doctors and nurses straight in the eye like she owned the joint. She brought a few smiles out, but we probably could have gone to urgent care that time.

What about all of the viral 105 degree fevers my son spiked repeatedly as meds wore off? Or the strange hives that appeared on my daughter’s torso after just one trip to a 1920’s era apartment building basement? Then there were the relentless stomach bugs that made me feel like I might need the ER eventually.

Those typical childhood illnesses were miserable. Sometimes they were a little unnerving. But no one’s life was in danger. Taking my kids to the ER for childhood fevers or weird rashes or tummy bugs would just have exposed them to heaven knows what else. They would have been far more miserable with all of the waiting and poking and prodding, when they could have been resting and getting better in the comfort of our home.

Where you go matters. Not just in terms of coverage. But also weighing risks and benefits, and thinking about comfort.

But What About Those Tougher Calls?
Beyond the infections and injuries that are the stuff of parental “character building,” there are moments that parents remember like they were yesterday - the inevitable, heart-stopping accidents your children experience over the years. Life happens, and with a particular vengeance for the curious and active.

These moments often require immediate decisions and result in (possibly big) bills down the road. As we were brainstorming any new ways we might talk about deciding between the ER and urgent care, I realized I have my very own collection of examples. In one, maybe two of my examples, I wonder if urgent care might have been a better choice.

Heart-Stopping Parenting Moment #1
It was New Year’s Day, our first in a new city. We had two young kids, so it had been a low key evening the night before, but I still wanted my latte before I dove into housework. In the ten minutes it took me to run for coffee, our five year-old son begged his dad to take him bike-riding. Frigid New Year’s Day. So not happening!

Dad decided to open the window and let our son feel the temperature outside. Unfortunately, all fingers were not clear of the window when it came back down (big, old, heavy window). So I returned to chaos. My son was screaming in pain with a rapidly swelling finger. Dad had been trying to comfort him and see how bad it was. Suddenly, my latte was forgotten after a rush of adrenaline.

While Dad went for the children’s pain relief medicine and a bag of ice, it became clear the finger needed to be seen and probably X-rayed. I still had our younger daughter at home, so I sent Dad and little guy to the nearby university ER. As you might imagine, they spent the better part of the day being seen, getting X-rays, and getting a temporary splint and a referral to an orthopedist.

It turned out the middle bone of the finger had been crushed, basically cracked down the middle end to end. But was it a break that could have been managed at an urgent care facility?

Heart-Stopping Parenting Moment #2
Five years after the finger-versus-window incident, our son encountered…a car. The poor guy had just biked on his own to our local library less than a mile away. There was only one busy street on the way, and we had crossed it countless times, in a well-marked cross walk. He was walking his bike across that street like he promised. Unfortunately, someone decided not to wait behind the vehicle that had stopped for my son. While I rushed home from work in a cab, a family member greeted our dazed, bruised little man.

The accident was literally a block from our police department, and a paramedic had apparently cleared him, but all we really knew was the bike and helmet seemed to have taken the brunt of the collision. He just had huge bruises on his hip and thigh, but still, our pediatrician wanted him checked by someone qualified in trauma. She called ahead and we headed for the local ER.

Our pediatrician had not gotten the chance to say much more than “hit by a car” when she called ahead, so the ER staff were shocked when we walked in. We were ushered into what turned out to be a “trauma suite.” Staff proceeded to hook our guy up to every imaginable gismo while we waited for a trauma surgeon to come examine him. When the trauma surgeon arrived, he poked and prodded and shined lights here and there, but unhooked us and sent us on our way pretty quickly. That very short visit came to thousands of dollars. My copay was nearly $1000! It is hard to put a price on peace of mind, but would an urgent care facility have been have been enough? What do you think based on these guidelines?

Heart-Stopping Parenting Moment #3
Fingers versus a window, or a pedestrian who can still walk after being hit by a car, both are examples of when the ER versus urgent care question may not have an obvious answer. Then, there are the undeniable ER events. Not five minutes into the first football game of the year, my son broke his leg - BADLY. As paramedics loaded my son onto a gurney, I answered a policeman’s questions in a daze as my mind raced ahead to what I was going to do about our daughter. I was pretty sure we were going to hear the word “surgery” in short order and I was on my own that weekend. Sure enough, that afternoon, they put a titanium rod through the full length of my son’s tibia, attaching it with screws in the ankle and knee.

As it turns out, the policeman took my information not just for an incident report, but for the bill for the ambulance (ouch!). I cannot imagine driving anyone in that much pain myself and I’d be darned if we were going anywhere but the ER! The only question I had to answer that day was which ER (yes, they asked).

Do you know where to go for your care? Ask us your questions in the comments!