In-person, Virtual, Urgent Care or ER Visits: How to Know Where to Go

Warren Clinic and Saint Francis patients have many options for seeing a healthcare professional – parents might take their child for an in-person pediatric visit, an e-visit or virtual pediatric visit. They may visit an urgent care in person or choose a virtual urgent care visit. For immediate, serious illnesses or injuries, they may need to go to the emergency room. How do parents know which one to choose and when? Dr. Jeffrey Rice, with Saint Francis Children’s Physicians, answers these questions and more.

Q: We know what a regular visit to a pediatrician’s office is like, but there are also virtual pediatric visits. When would you suggest a virtual visit?

A: It really depends on the severity of the illness or injury. Most of the time in pediatrics, we want to see the child in person because kids are fickle at best. They may have trouble describing symptoms. Sometimes you can tease those things out of them, but it really depends on the age of the child. With older children, a virtual visit may be perfectly acceptable. For example, if your kid has had a cough for a week, but no fever or other issues, we can look at them over the camera and evaluate them. Something like a sinus infection where there’s minimal symptoms might be good for a virtual visit.

Q: What about an e-visit? When might that be appropriate?

A: An e-visit is offered through MyChart and is a quick conversation using text messaging and photos. You can attach up to two pictures with an e-visit. It works great for something like a rash that you can take a picture of, and we can see it. A bug bite or a rash might be infected, and we can see that. Then, if we need to ask questions or bring you in, we can. As long as you can get a really good picture, it works well. The nice thing is, we can kind of triage and say, “OK, based on that picture, I need to see you in person,” especially if you’re worried about something. It gives us a good starting point.

Q: What are some symptoms that you would insist on an in-person visit?

A: I think we kind of lag behind a little bit in pediatrics because, as I said, kids are fickle at best, so we still like to see them in person. But I think we’re being more open to the idea of virtual visits as the technology increases and improves. The hardest thing to address virtually would be something like an ear infection, pneumonia, or any kind of concern for appendicitis or a stomach pain where you can’t push on a belly. Those are things that I definitely would not do as a virtual visit.

Q: When would you suggest that a child go to urgent care in person?

A: I always recommend calling your pediatrician first. If it’s during the business day, most of us have spots where you can get in and be seen that day. However, if you have an immediate injury like a possible broken bone that needs setting or imaging quickly, or something acute like a sore throat and you can’t get in to your pediatrician’s office that day, urgent care would be appropriate.

If you’re going to urgent care, I would usually go there for an injury that’s not life-threatening, where there’s no decompensation, or worsening condition. It might be an injury that needs small stitches or a concerning illness that needs immediate attention. Other times you might go to urgent care is if your child can’t keep water or Pedialyte down and you’re concerned about dehydration, or they have acute symptoms that are worsening if you don’t deal with them immediately and you can’t get in to see the pediatrician that day.

Q: What about virtual urgent care?

A: Virtual urgent care is a new program that came about with COVID, where people didn’t want to be seen in person or they were afraid of catching something if they went to urgent care in person. That really progressed the technology. You would just see an urgent care provider rather than your normal, everyday provider.

There are also some options similar to the e-visit, where the provider will ask you a bunch of questions about your symptoms and go through the whole history with you. They can then determine whether you need an antibiotic or something simple just through the questionnaire. Sometimes you don’t even have to see a provider.

Q: If virtual urgent care felt more testing or treatment was necessary, would they tell you to come in at that point?

A: They would. They’d just tell you to go to the lab. So, let’s say you come into my office, and I think you had strep pharyngitis. I would do the exam and determine whether you needed the test or not, and then we would do the test. I would call you with the results and send an antibiotic if you needed it.

With virtual urgent care, they’re going to do the same thing. The difference is that you don’t have that initial in-person evaluation, so they’re going to go based off the symptoms that you’re telling them on that questionnaire, and then they’ll say, “OK, yeah, I think you do need a strep test.” You will have to go to the location to do that. You would just go in, get the test, and then you’d get a call with the results a little while later.

Urgent care and virtual urgent care can be great options during evening hours or on weekends.

Q: When should you take your child to the emergency room?

A: Any obviously near-fatal accident. I hate to mention it, but it’s summertime: drowning. Absolutely get to the ER. Any sort of respiratory distress, where your child is breathing fast or they’re retracting, or they are having trouble completing a sentence, absolutely make an ER visit. Any color change is an emergency. A color change to a body part, color change to a specific area like around the mouth or if they’re turning blue or anything like that, those are all immediate, ER situations. If they are vomiting to the point where they truly cannot keep down water, where they literally cannot keep down anything and they’re progressing, go to the ER. If a child or baby is having less than around three wet diapers in a 24-hour period, that would be a time to be seen, especially if there’s acute decompensation. Like I said, kids will do well and do well, and then you see an acute change. That’s something that needs to be seen immediately. Do not wait for the pediatrician tomorrow.

Q: You mentioned drowning. Are there more emergency room visits during the summer months? Is there a seasonal aspect to any of this?

A: Summertime has more drownings, ATV accidents and more heavy machinery incidents. Snake bites are another one that I would go to the ER for.

In the winter, you’re typically looking more at respiratory distress.

Broken bones happen in both. That would be potentially an ER visit, especially if it’s open — and by open, I mean exposing bone, muscle, things that you normally shouldn’t be able to see.

Q: Summer might be a time parents need to take advantage of a virtual visit when they are away from home – maybe at the lake or camping.

A: Absolutely. A virtual visit or e-visit would be great. You know how your child feels and looks. If it’s something simple like, “Hey, I need to check this out. He’s vomited twice.” OK, cool. You might need some Zofran and go from there. If it’s something like, “Hey, I stepped on a rusty nail,” they probably need to be seen in person.

The main thing is that with any of these visits, if your child needs something more, we can guide you to the right place.