The tummy ache dilemma

It's after 5 p.m. and your child is entering the eighth hour of a fever, accompanied by a runny nose, clammy skin and a bucket-full of tears. As a parent you are naturally concerned and decide to seek medical advice. But where do you go - the local doctor, CLSC or hospital Emergency Room?

According to Dr. Dominic Chalut, director of Emergency Medicine at the Montreal Children's Hospital of the McGill University Health Centre, this is a common dilemma for parents. Understandably, they want immediate answers and treatment for their child, but is a hospital ER really the best option, even after hours?

"The Children's ER has an exceptionally high quality of health care," says Dr. Chalut. "But it is not necessarily an optimal location for immediate treatment of non-urgent cases like tummy bugs and colds." Children at the MCH ER are assessed on a case-by-case basis - rather than first come first served - so the sickest receive treatment first. As a result, children considered non-urgent are often bumped down the waiting list as higher priority cases arrive.

"ER waiting times can change rapidly and are therefore hard to predict," says Chalut. "But it is not uncommon for a child considered non-urgent to wait many hours for treatment." The Children's has one of the busiest pediatric ERs in the country, receiving over 65,000 patients each year. According to Chalut, many of these cases are non-urgent. It is a situation that places undue pressure on ER staff and is a source of frustration for concerned families awaiting treatment.

Most families know that visits to an ER are rarely brief; why then do some many parents bring their children to the ER for minor illnesses? Quite simply, parents are concerned about their child and are not sure how bad the illness is. "This is only natural to play it safe," says Chalut. In reality, however, children are rarely as sick as their parents believe. In the first two years of life kids become sick countless times and fevers that last for days are not uncommon. "At any given time, in Montreal alone, we might expect between 2,000 and 3,000 children to have a fever," says Chalut.

It is also no surprise that peak-time at the ER is the evening - the time when most doctors offices and CLSCs are closed. "Everyone knows the ER operates 24-7," says Chalut. "But patients may be surprised to learn that many family doctors still welcome calls after hours." For some patients, however, a hospital ER is first choice for health care simply because they do not have a doctor. Whenever possible Dr Chalut recommends local doctors and provides information on CLSCs for the future. "Local centers are always best for minor conditions," says Chalut. "These doctors develop relationships with their patients, and can get to know the particular conditions of their patients; it is something that we at the ER do not the pleasure of doing."

At the end of the day however, patients should always come to the ER if they are in doubt. "We simply want what is best for our patients, and this means providing them with the information they need to make the right decisions," says Chalut. "If you are worried, play it safe and visit the ER."

By Ian Popple - MUHC