Convenient Care Comes at a Cost

Dr. Robert Shanik and Dr. Ira Haimowitz of Pediatric Affiliates reached out to The Voice to express concern over the growing reliance on urgent care centers and other forms of convenience-based medicine, which they say is contributing to fragmented care and, in some cases, substandard treatment.

In 1967, the American Academy of Pediatrics (AAP) introduced a concept called the “medical home.”

That meant that the pediatrician’s office should be the place where a parent brings their child to have all their medical needs met. They would receive their annual physical exams, their growth and development would be tracked and documented, and immunizations would be given. They would go there for all their ailments, whether physical, emotional, or behavioral. Any questions or concerns that a parent or child might have would be addressed, and everything would be entered into the medical record.

Even if the child did not always see the same practitioner within the pediatric office, the child’s medical record would be easily accessible to any practitioner in that practice. This would help guide any decisions that needed to be made that day. If a patient needed to be seen by a specialist, a referral would be made, and the specialist would send a report of their findings, which would then be entered into the child’s medical record.

This is what the ideal medical home should look like, and for many decades, it did. Unfortunately, today, the medical home is a broken one.

In recent years, we have seen more and more people stop utilizing the medical home concept, sacrificing proper medical care for the sake of convenience.

For example, if a child appears ill, the parent might decide it is easier to visit the urgent care center on the corner rather than call their pediatrician’s office, make an appointment when one is available, and drive there.

Some parents do not even do that. They opt for a “home visit” service that does not send a doctor, nurse practitioner, or physician assistant to the home, but instead sends a “technician” with little medical training. This technician might, for example, be able to take a throat culture, but they have no qualifications to actually look inside the child’s throat or ear. Instead, they use cameras to take a picture of the throat or ear, which they then send to an outside practitioner to examine.

The practitioner never gets to see the patient or truly assess the child’s overall well-being because no actual examination is performed.

This is all very convenient. But is it good medicine? We think not.

Besides the risk of the child potentially being misdiagnosed, there may be no record of the visit sent to the family’s pediatrician.

As convenience has taken precedence over sound medical care, we have seen potentially life-threatening illnesses that could have been missed if the family had not brought the child to us the following day, when corrective measures could be taken.

“More and more people have stopped utilizing the medical home concept, sacrificing proper medical care for the sake of convenience.”

Recent Examples We Have Experienced

Recurring Ear Infections

A father came to our office with his young daughter, who was our patient, and asked the doctor if she should have tubes placed in her ears due to recurring ear infections.

However, the chart in our office did not contain a single recorded ear infection. As it turned out, the girl had experienced 10 ear infections during the past year. In each case, the father had used whichever urgent care center or home-visit service was most convenient.

Each provider treated the girl without any knowledge of her previous conditions. Her primary care practice had no knowledge of any of these visits, and neither we nor any practitioners we had trained and trusted had diagnosed her.

An Unnecessary Throat Culture

Just the other day, a mother brought her cranky three-week-old baby boy to an outside urgent care center. Because some of his siblings had strep, the practitioner decided to perform a throat culture, despite recommendations from the AAP and the Infectious Diseases Society of America regarding children under age two.

The throat culture was positive, and the child was started on antibiotics.

Thankfully, the mother called us to ask for our opinion. We told her to bring the child in. It turned out that the baby was cranky due to gas and colic. His throat was not even red.

Following the appropriate guidelines, we did not perform another throat culture because the child was under age two, and a positive result in a child of this age may be a false reading or otherwise clinically insignificant.

Many urgent care centers in the area are performing throat cultures on every child in the household, including children as young as six months, even when there is no medical indication to do so.

Between 12% and 24% of children are known to carry strep bacteria in their throats. When these children are cultured, their results may be positive. However, they do not necessarily need treatment because they are not sick, and the strep bacteria in their throats may never cause harm.

By performing unnecessary throat cultures, a practitioner may identify these carriers and prescribe antibiotics needlessly.

A Rash That Was Not an Allergic Reaction

A parent of a two-year-old with a rash had a technician come to the home. The technician took a picture of the rash and sent it to an outside practitioner, who said it was an allergic reaction and recommended Benadryl.

Fortunately, the parent subsequently brought the child into our office. This was not an allergic rash. The child had bruises all over her body caused by a condition called immune thrombocytopenia, or ITP, which causes a very low platelet count.

We immediately sent her to Children’s Hospital of Philadelphia for evaluation, treatment, and transfusions. If the parent had simply given the child Benadryl, she could have suffered serious complications or even died.

An Unknown Antibiotic

In another recent case, a parent told us their child was taking an antibiotic but could not remember which one. We did not know either because another practitioner had prescribed it, even though Pediatric Affiliates was the child’s primary care office.

These are just several of the increasing number of cases we are seeing in which children are not being examined in traditional pediatric offices. This creates the potential for misdiagnosis and, equally importantly, a lack of continuity of care.

“All too often these days, it feels like we’re practicing in the dark.”

Of course, in some cases, people do not go to an urgent care center because of convenience. Sometimes, it is because a child becomes ill late at night. However, many pediatricians in Lakewood offer nighttime hours. We are open until 10 p.m., and many others have similar hours.

If your child becomes ill after hours, please call your primary care office before making a decision. Doctors have emergency numbers. Your doctor can tell you whether the concern can wait until the office opens in the morning or whether immediate attention is needed.

If you do visit an urgent care center, follow up with your child’s doctor right away so they know what the child was diagnosed with and which medications were prescribed. That information can then be entered into the child’s chart, and your doctor can determine whether the child should be seen for a follow-up visit.

We know some people reading this may say that we are simply trying to criticize the competition. As doctors who have dedicated our lives to caring for the children of Lakewood and the surrounding communities, we are speaking out because we are concerned.

We do not care whether you are a patient of Pediatric Affiliates or one of the other fine pediatric offices in town. We simply want to ensure that every child in our community receives the best care possible.

The medical home works, and we recommend that families use it. Do not sacrifice your child’s health for convenience.

Checkup Chat

Dr. Shanik and Dr. Haimowitz also answered questions about several other timely medical issues.

Summer is almost here. What are some important safety issues parents should keep in mind?

Dr. Shanik: First, children should only be allowed to swim when supervised by an adult and, preferably, a lifeguard. Four-sided pool fencing without direct access from the home should be installed around all pools.

Second, ticks are quite common in this area. After coming inside, you should check your entire body for ticks, and parents should check their children. Focus on the underarms, hairline, ears, and groin area, since these are common places for ticks to embed.

Prompt removal of a tick within 24 hours of the bite minimizes the risk of Lyme disease transmission. DEET insect repellent at a strength of 20% to 30% is safe to use in children two months and older. Wear light-colored clothing and long sleeves, and tuck pants into socks.

Sun protection is crucial for children and adults. For children younger than six months, shade and covered areas are safest. For children six months and older, sunscreen with an SPF of at least 30 should be reapplied every two hours.

Wear sun-protective clothing, including wide-brimmed hats and sunglasses.

Children are also more susceptible to heat-related illnesses such as heatstroke. Adequate hydration, lightweight clothing, and limiting physical activity during peak heat hours—between 10 a.m. and 4 p.m.—are all important measures.

Vehicular heatstroke is the leading cause of non-crash, vehicle-related deaths among children in the United States. Never leave children unattended in a car. Place personal items, such as a bag or phone, in the back seat as a reminder to check the rear seat. Keep vehicles locked to prevent children from entering them without supervision.

Many children ride e-bikes and e-scooters during the summer. What should parents know?

Dr. Shanik: E-bikes and e-scooters are extremely dangerous. We would not recommend them at all. We see injuries every day, including patients in the hospital with head trauma, concussions, and fractures.

I do not think any child should ride an electric bicycle or scooter, even with a helmet. I know some people will not agree with me, but they should come to my office for a day and see what I am talking about.

There has been a significant increase in autism diagnoses in recent years. To what do you attribute this?

Dr. Shanik: People know more about autism now than they did 20 years ago. We, as well as parents, are more aware of what we are looking for. We are more educated consumers than we used to be.

Dr. Haimowitz: The definition of autism has changed over the years. In the past, a child considered autistic would typically have been nonverbal and unable to engage in social interactions. That was the understanding of autism decades ago.

Today, we have what is called autism spectrum disorder. It might mean that someone has some social difficulties or unique behaviors but is still a functioning and active member of society.

The significant increase in the number of people diagnosed with autism today is largely a byproduct of the medical community expanding the definition of which symptoms qualify someone to be placed on the spectrum, rather than evidence of an “autism epidemic.”

About one in eight American adults has reportedly taken a GLP-1 medication, such as Wegovy or Ozempic, for weight loss. What do you think of these medications, and do you prescribe them to adolescent patients?

Dr. Haimowitz: The AAP recommends that adolescents ages 12 and older with obesity may take these medications.

Medication should not be the first solution presented to a child with obesity. We try other options first, including nutrition and exercise counseling. We give children every opportunity to make lifestyle changes that, when implemented correctly, can make a meaningful difference.

Sometimes, you can speak with a patient and offer guidance, but when they return six months later and their weight has increased, they may be entering dangerous territory with a body mass index of 30 or higher. Obesity can have significant long-term medical effects, which we want to avoid whenever possible.

At that point, there are two alternatives to consider. One is beginning a GLP-1 medication such as Ozempic or Wegovy. The other is a referral to a bariatric surgeon for a procedure such as a gastric sleeve. Both may be recommended for adolescents ages 12 and older when lifestyle changes have not been successful.

As with all medications, GLP-1s can cause side effects, including constipation, nausea, diarrhea, and vomiting. The primary issue seen so far is the potential for weight regain after stopping the medication. If a patient reaches their desired weight and stops taking the medication, the lost weight will usually return.

This is probably because the patient has still not made the lifestyle changes they should have been developing while taking the medication. Medication alone is not the answer.

That is why some patients choose bariatric surgery, which, statistically speaking, may provide more lifelong benefits once it is performed.

“If a patient stops taking a GLP-1, the lost weight will usually come right back.”

If a pregnant woman asks whether she should take Tylenol, what do you tell her?

Dr. Haimowitz: If it is being used for a fever or significant pain, yes, she can take it.

Dr. Shanik: I do not think pregnant women should take Tylenol every time they have a minor low-grade fever or headache. However, if they need a pain reliever, it is considered safe.

Dr. Haimowitz: Many studies have compared the same mothers during different pregnancies. A long-term study in Sweden examined mothers who used Tylenol during one pregnancy and did not use pain relievers during another.

The incidence of autism within these families was the same whether the mothers took Tylenol or not. This suggests that genetics and possibly other environmental factors may play a greater role in autism outcomes.

There is no similarly safe alternative to Tylenol for a pregnant woman. A high fever or severe pain can be harmful to the developing fetus. Ibuprofen and aspirin may also create serious risks during pregnancy, including cardiac, renal, and bleeding complications.

Wasn’t there a study showing a correlation between Tylenol use during pregnancy and autism?

Dr. Haimowitz: One non-reproducible study showed a 0.09% correlation, which is statistically insignificant.

Is it dangerous for teenagers to vape if they are only vaping tobacco, not marijuana, and do not transition to cigarettes?

Dr. Haimowitz: Yes.

If you had asked a doctor 70 years ago whether cigarette smoking was bad for you, they might have said no. At the time, people thought smoking could help control weight and reduce anxiety. We did not know then what we know now about the risks, including heart disease, lung disease, and many forms of cancer.

In 2026, we are still in the relatively early stages of understanding the effects of vaping. What we do know is that vaping may release numerous potential toxins into the lungs. When liquid passes through metal coils, particulate matter may be inhaled.

We will not have long-term follow-up studies of people who vape for many years, but I think it is safe to say that the findings will not be good.

We also know there have been reported cases of severe acute reactions to vaping in which a teenager arrives at the emergency room unable to breathe. A chest X-ray may show that the lungs have been severely damaged by an acute chemical reaction. This damage may be irreparable and can result in major lifelong lung problems.

This does not happen often, but the concern is that no one knows why it occurs or who may be affected.

Unfortunately, vaping is extremely common among our teenage patients. I sincerely hope messages like this spread throughout the community and help teenagers understand the dangers of this highly addictive habit.

Dr. Shanik: Vaping may also cause serious and potentially permanent effects on the brain.

The longer someone vapes, the greater the potential adverse effects. Many people who have vaped for an extended period report difficulty concentrating, understanding information, thinking clearly, and responding appropriately to outside stimuli. That is something young people should seriously consider before vaping.

Is there anything you would like to add?

Dr. Haimowitz: I would like to add one point about the medical home issue we discussed earlier.

Behavioral health is a very important component of a child’s overall health. More people are experiencing conditions such as ADHD, anxiety, and depression. Finding a mental health practitioner who accepts your insurance or does not have an extensive wait for an appointment can be very difficult.

It is extremely beneficial when pediatric practices have a mental health provider in the office, as we do.

For example, adolescent patients frequently come to us with chronic headaches, stomach pain, or fatigue. Often, their physical examinations and bloodwork come back completely normal. This is when a practitioner must have a strong understanding of the role mental health conditions can play in a patient’s physical symptoms.

The mind and body cannot be treated as two separate entities. Being able to address both components in one setting is extremely advantageous to the well-being of a child or teenager.

First published in The Voice of Lakewood. Reprinted with permission. All rights reserved.