My wife and I are no longer taking our kids to urgent care.
Several months ago, our son was digging at his ear. He was two-and-a-half years old, and saying, “Ear hurt.”
Some quick backstory: our son has had multiple ear infections; he seems to get an infection every couple months. He had tubes put in, but they didn’t help one iota—in fact, one fell out rather quickly. Because of this, we’ve become fairly attuned to signs he’s not well. Whenever he digs at his ears and acts out of sorts—crying and wanting held, as opposed to his usual cheerful wanting-to-scurry-about self—we get his ears looked at. Nine times out of ten, yup: ear infection. Now that he’s actually able to communicate “ear hurt,” we trust he knows what he’s saying and take him in for a gander.
We took him to urgent care and were told, “Looks like an infection. Better start him on antibiotics.”
I dutifully picked up the prescription and gave him a dose that night. As chance would have it, the very next day we ended up having to take him to a pediatrician—not his regular one—for something non-ear related. While there, we told the doctor about the infection diagnosis from urgent care. After helping us with the current medical necessity, he performed a quick exam.
His brow furrowed, and he said thoughtfully, “It’s slightly pink in there, yes, but there’s no fluid or pus. It could develop into an infection, so if he gets a fever, he’s got one. But I wouldn’t rush to antibiotics yet.”
Basically, he didn’t want to pump antibiotics into a toddler.
We stopped administering the medicine we had, and within a day our son was fine.
Cut to recently.
Once again, our son told the teachers at daycare his ear hurt. They said he had been sticking his index finger in there most of the day. Upon hearing this, back to urgent care he and I went.
While there, the nurse practitioner on duty took a look and determined, “OK, the right ear is completely clear. Nothing wrong there. The left ear, that I can’t see into. There’s a large amount of wax buildup, so I can’t see inside. I’m going to prescribe an antibiotic just in case there’s an infection behind it.”
I was confused and asked, “Can’t you scoop the wax out and take another look?”
The answer was “no.”
I was dumbfounded. I had seen our pediatrician remove wax from our kids’ ears on several occasions. What was preventing that from happening here?
I declined the prescription, thanked her, left, and immediately called my wife and explained the situation. She agreed that jumping to antibiotics seemed sketchy, and made an appointment for our son to see his regular pediatrician the next day.
At that appointment, the wax was quickly and cleanly removed from my son’s ear canal. Following that, a quick eyeballing revealed the following: the left ear—previously full of wax and rendered un-diagnosable at urgent care—was fine. The right ear, however, had a perforated drum. It was severely infected, to the point that too much pressure had built up and popped it.
Keep in mind, this was the ear the nurse practitioner at urgent care had said was healthy.
Two trips to the urgent care means two different caretakers saw him. This wasn’t one person screwing up twice, this was two different professionals, each under-performing at their task.
Which, mind you, is a serious task. If a waiter brings you the wrong drink or meal, no harm no foul; you send it back. When a medical professional begins incorrectly diagnosing ailments and/or throwing out prescriptions, that is a problem.
Given the antibiotic-resistant superbugs out there now, you’d think prescriptions would be doled out cautiously. Unfortunately, our pediatrician believes urgent care tends to be a little too eager to offer antibiotics.
What does all this have to do with Obamacare?
The Affordable Care Act was, in part, designed to reduce medical costs by keeping people out of the emergency room—people without insurance tend to go to emergency rooms, because they won’t be turned away. The belief was that if people could, they would visit an urgent care clinic. In fact, many plans cover urgent care trips better than they do trips to a physician or ER, because the cost pecking order goes emergency room, physician, urgent care.
This creates two problems.
One, the urgent care industry has become a behemoth. In 2014, the industry was valued at $14.5 billion. When a business gets too large or expands too quickly—as urgent care has—quality control can go out the window. Suddenly, antibiotics becomes the go-to answer, which is irresponsible at best and downright dangerous at worst.
Remember when the np couldn’t see into my son’s wax-filled ear? The solution was: better take antibiotics. While he did end up having an infection, albeit in the other ear, I don’t think throwing antibiotics at a dartboard is a viable medical solution.
Why? According to a recent article in The Atlantic, 700,000 people will die because of antibiotic-resistant disease in 2017.
Over-prescribing leads to ineffective drugs.
Nature always finds a way to mutate and survive, and at the moment diseases are mutating faster than antibiotics can keep up.
The second problem is that my son had an unmistakable ear infection—one so bad it led to his perforated eardrum. It was completely missed at urgent care. I know the rule is “three strikes and you’re out,” but we’re stopping at two. Two incorrect diagnoses in a row, combined with a willingness to prescribe antibiotics at the drop of a pin, is two too many.
Especially where my kids are involved.
(It also makes me wonder how many of his previous ear infections were misdiagnosed.)
Look, I know my family is incredibly lucky. We have coverage that allows us to forgo urgent care for physicians and pediatricians. But imagine the flocks of new people entering the marketplace and receiving unnecessary prescriptions. Antibiotic-resistant superbugs could get much worse than they already are.
That should scare everyone.
(Did’ja like the title of this piece? It’s one of the few times I really went all-out clickbait. Heh.)