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.

 

By Dr. Robert Shanik and Dr. Ira Haimowitz

 

 

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 get 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 for any practitioners in that practice, which would help a practitioner 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 his 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 are seeing that more and more people have stopped uti­lizing this medical home concept, sac­rificing proper medical care for the sake of convenience.

 

For example, if a child appears ill, the parent might decide it’s easier to pop over to the urgent care on the corner, rather than calling their pediatrician’s office, making an appointment when one is available, and driving over there.

 

Some parents don’t even do that; they opt for a “home visit” service that doesn’t send a doc­tor, NP, or PA to your house, but 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 have cameras that can take a picture of the throat or ear, which they then send to an out­side practitioner to examine. The practitioner never gets to see that patient or to truly be able to assess the overall well-being of that child since no actual examination is ever done.

 

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

 

Besides the risk of that child potentially be­ing misdiagnosed, there is now no record of that child’s visit that will ever be sent to the fami­ly’s pediatrician.

 

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

 

Here are some recent examples we’ve experienced:

 

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

But in the chart in our office, we did not have a single recorded ear infection. As it turned out, the girl had had 10 ear infections in the past year, and in each case, the father had used whatever urgent care or home-visit service was most convenient.

Each provider was treating the girl without any knowledge of her past conditions, and the girl’s ostensible primary care practice had no knowledge of any of this, and neither we nor any practitioners we have trained and trust have ever diagnosed her.

 

— Just the other day, a mom brought her cranky three-week-old baby boy to an outside urgent care. As some of his siblings had strep, the practitioner at this ur­gent care decided to do a throat culture (against the recommendations of the AAP and the Infectious Disease Society of America for chil­dren under age two). The result of the throat culture was positive, and the child was started on antibiotics.

Thankfully, the mother called us to ask our opinion of this. We told her to bring the child in. It turned out that this child was just cranky due to gas and colic. The child’s throat was not even red.

Acting properly, we did not do a throat culture on the baby since the child was under the age of two and any positive throat culture is either a false reading or otherwise meaningless strep in a child of this age.

Many urgent cares in the area are do­ing throat cultures on every single child in the house from six months on up even when there’s no medical indication for that. Between 12 percent and 24 percent of children are known to be carriers of strep in their throat. This is a condition that means that when that child is cul­tured, the result will be positive.

These children, however, do not need to be treated since they are not sick and the strep in their throat will never harm them. By doing unnecessary throat cultures, a practitioner will be picking these carriers up and prescrib­ing antibiotics needlessly.

 

— 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 a rash due to an allergic reaction and put the child on 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 ITP, which causes a very low platelet count.

We immediately sent her to CHOP for evaluation and treatment and transfusions. If that parent had just given the child the Benadryl, she could have suffered seri­ous complications or even died.

 

— In another recent case, a parent told us their child was on antibiot­ics but couldn’t remember which one, and of course we didn’t know, be­cause the child had been prescribed it by another practitioner—even though Pediatric Affiliates is his primary care office.

 

 

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

 

All too often these days, it feels like we’re practicing in the dark, making it extremely difficult for us to practice proper medicine.

 

Of course, in some cases, people don’t go to an urgent care because of conve­nience; sometimes it’s because someone is feeling ill late at night. However, many pediatricians here in Lakewood have nighttime hours; we are open until 10 p.m. and many others have similar hours.

 

If your child does become ill after hours, please call your primary care office before making any decision. All doctors have emergency numbers. Your doctor will tell you whether you can wait until the office opens in the morning or whether immediate care is needed.

 

And if for whatever reason you do go to an urgent care, at the very least follow up with your doctor right away, so he can know what the child was diagnosed with and what medications were prescribed. That information can then be entered into the child’s chart and your doctor can tell you whether the child should be seen in their office for follow-up.

 

We know some people reading this may say we are just trying to knock the competition. If you want to believe that, go ahead. As doctors who have dedi­cated our lives to caring for the chil­dren of Lakewood and the surrounding towns, we are speaking out because we are concerned.

 

We don’t care if you are a patient of Pediatric Affiliates or of any of the oth­er fine pediatric offices in town. We just want to ensure that all the children in our community are getting the very best care possible.

 

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

 

***

Checkup Chat

 

By Reuvain Borchardt

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

 

 

The summer is almost here. What are some important safety issues for parents to keep in mind?

 

Dr. Shanik: First of all, 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 on all pools.

 

Number two, ticks are quite common in this area, so after coming in from outside, you should check your whole body for ticks, and parents should check their children. Focus on the under­arms, hairline, ears, and groin region since these are favorite areas of the body for ticks to embed.

 

Prompt removal of a tick within 24 hours of the bite minimizes the risk of that tick transmit­ting Lyme disease to a human host. DEET insect repellent at a strength of 20–30 percent is safe to use in children two months and over. Wear light-colored clothes, long sleeves, and tuck pants into your socks.

 

Sun protection is crucial for all children as well as adults. In children younger than six months, shade and covered areas are the safest. In children six months of age and older, a sunscreen containing at least SPF 30 should be applied every two hours.

 

Wear sun-protective clothing including high-brimmed hats and sunglasses.

 

Children are more susceptible to heat-related illnesses like heat stroke. Adequate hydration, lightweight clothing, and limiting physical activ­ity during peak heat hours (between 10 a.m. and 4 p.m.) are all important measures to take.

 

Vehicular heat stroke is the leading cause of non-crash, vehicle-related deaths in children in the US. Never leave children unattended in a car. Place personal items in the back seat like a bag or a phone as a reminder to check the rear seat. Keep vehicles locked to prevent unauthorized entry by children.

 

Lots of kids are riding e-bikes and e-scooters in the summer. Hatzolah of Boro Park actually felt compelled to put out a warning with some graphic footage of kids getting into accidents.

 

Dr. Shanik: E-bikes and e-scooters are really dangerous. We wouldn’t recommend them at all. We see injuries every single day, patients in the hospital with head trauma, concussions, frac­tures. They’re not careful. I don’t think any child should ride an electric bike or scooter, even with a helmet.

 

I know some people will not agree with me on this, but they should come to my office for a day and see what I’m talking about.

 

There has been a massive uptick 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’re looking at. We’re more educated consumers than we used to be.

 

Dr. Haimowitz: The definition of “autism” has changed over the years. Back in the day, a child con­sidered autistic would typically be a non-verbal child who would not be able to have any social in­teractions whatsoever. That was the autism of de­cades ago.

 

But now we have what’s called “autistic spec­trum disorder.” It might mean someone has a bit of quirkiness or some social issues but they are func­tioning and active members of society.

 

The significant increase in the number of people diagnosed with autism today is largely a byproduct of the medical community changing the definition of what symptoms qualify one to be placed on the spectrum, and not truly an “autism epidemic.”

 

Studies have shown that about one in eight American adults has taken a GLP-1 drug like Wegovy or Ozempic for weight loss. What do you think of these drugs, and do you prescribe them for your adolescent patients?

 

Dr. Haimowitz: The AAP recommendation is that adolescents 12 and older with obesity can take them.

 

Taking medications should not be the first solu­tion presented to an obese child. We try other alter­natives first, like nutrition and exercise counseling. We give them every opportunity to make lifestyle changes that, when done correctly, can make all the difference for that child.

 

Sometimes you can talk and give advice to that patient, but when they come back six months later and their weight has gone up, then they’re getting into dangerous territory with a body mass index of 30 or higher. That person’s obesity can have major medical effects down the road for them, and that is something we most definitely want to avoid if at all possible.

 

At this point there are two separate alternatives to offer this type of patient. One would be the op­tion of starting a GLP-1 medication like Ozempic or Wegovy. The other option would be a referral to a bariatric surgeon for a procedure like a gastric sleeve. Both are recommended for kids 12 and older when lifestyle changes have not been successful.

 

As with all medication, there are some side ef­fects with GLP-1s, like constipation, nausea, di­arrhea, and vomiting. The main issue with these medications that has been shown so far is that there are rebound concerns for those trying to come off of them. If a patient says, “I’m at the weight I want to be, I’m good, I’ll stop taking the medication now,” the lost weight will usually come right back.

 

It’s probably because the patient has still not made the lifestyle changes they should have been doing all along while taking the medications. The medication alone is not the answer.

 

That is why in some cases people will go on to do bariatric surgery, which, statistically speaking, has more lifelong benefits once it’s done.

 

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

 

Dr. Haimowitz: If used for fever or significant pain, 100 percent yes, she can take it.

 

Dr. Shanik: I don’t think they should take Tylenol every time there’s a little low-grade fever or head­ache. But if they do need a painkiller, it’s safe. I don’t agree with “Dr. Trump.”

 

Dr. Haimowitz: Many studies have been done comparing the same mothers during different preg­nancies. A long-term study was done in Sweden, where a mother used Tylenol during one pregnancy and used no painkillers during another.

 

The incidence of autism in these families was the same whether they took Tylenol or not, meaning that what’s really playing a role in the autism outcome is genetics and maybe other environmental factors that we don’t always know about. I think that study is very conclusive, and it’s the largest one we have that proves that Tylenol cannot be linked to autism or to ADHD.

 

There’s no safe alternative to Tylenol for a preg­nant woman. If she has a high fever or is in severe pain, it can be very damaging to the developing fetus, including risks such as cleft lips and palates and can actually increase the incidence of autism. We have known for a long time that ibuprofen or aspirin is very unsafe for the fetus and can cause cardiac and renal disease as well as neonatal bleeding complications.

 

Wasn’t there a study showing some correlation between pregnant women who took Tylenol and their children having autism?

 

Dr. Haimowitz: One non-reproducible study showed a .09 percent correlation, which is statistical­ly insignificant.

 

Is it dangerous for teens to vape, assuming they are not vaping marijuana, just tobacco, and they don’t move on to cigarettes?

 

If you asked a doctor 70 years ago if cigarette smoking was bad for you, they would have said no, it’s good for you, it keeps your weight down and it makes you less anxious. We didn’t know then what we know now about all the risks that a smoker is taking, includ­ing developing heart disease, lung disease, and many forms of cancers if they continue to smoke.

 

In 2026, we’re still in the relatively infant stag­es of knowledge about vaping. What we do know is that vaping releases far more potential toxins into the person’s lungs than cigarettes do, because when the water goes through those metal coils, particulate matter is inhaled into the lungs. We won’t have long-term follow-up studies of vapers for many years, but I think it is very safe to say that the news will not be good.

 

We also know that there have been many reported cases of severe acute reactions to vaping, where a teenager winds up in the emergency room unable to breathe. A chest X-ray is done, and it shows that the lungs have basically liquefied. It’s an acute chemical reaction that destroys the lung tissue. It’s not repair­able, and that adolescent will have major lung issues and a very shortened life. This does not happen often, but the problem is no one knows why or to whom it might occur.

 

Unfortunately, the incidence of vaping is ex­tremely high amongst our teenage patients. I sincere­ly hope that messages like this will spread through the community and that teenagers will understand the dangers of this very addictive habit.

 

Dr. Shanik: Vaping also causes major permanent brain damage that’s irreversible.

 

The longer you vape, the more adverse effects to the brain. Many people who have vaped for a while are finding they can’t concentrate, they don’t un­derstand things, their normal thought processes are dulled, and they react very poorly to outside stimuli. That is not reversible and is cumulative as the weeks and months and years go on. That’s something you re­ally should think about before taking a vape.

 

Anything you’d like to add before we go?

 

Dr. Haimowitz: I’d actually like to add a point about the medical home issue we discussed previ­ously. Nowadays, behavioral health is a very import­ant component of a child’s health. More and more people are suffering from issues like ADHD, anxiety, and depression, and finding a mental health prac­titioner that either takes your insurance or doesn’t have extensive waiting times for an appointment is very difficult.

 

It’s extremely beneficial if pediatric practices have a mental health provider in their office as we do.

 

For example, adolescent patients frequently com­plain to us about suffering from chronic headaches, stomach pain, or fatigue. Often the physical exam and bloodwork come back completely normal. This is when a practitioner must have a good understanding of the role mental health disorders can play in a pa­tient’s physical complaints.

 

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

 

—

[email protected]