Your child fell, and has a scratch…or worse. The babysitter, school nurse, or your
sister who’s a drunk family member you used for child care has just called you to say that little Johnny is bleeding and you need to pick him up. What do you do?
As a plastic surgeon with 3 little ones wreaking havoc all over San Francisco, I know too well both sides of the this common predicament. I hope this article gives you some edification on the topic and helps you to understand the medical and health insurance implications of what to do.
- Do You Actually Need to See a Doctor?
- ER or Urgent Care?
- Plastic Surgeon- Yes or No?
- Short Term & Long-Term Follow-up
- WTH? Why is the Health Insurance Bill so High? And is This why Plastic Surgeons Drive Porsches
Do You Actually Need to See a Doctor?
It’s tempting to rush for the nearest hospital when you see blood all over your child’s face. But take a minute to assess the situation.
Generally, you can stop bleeding with direct pressure. But if it persists, don’t panic – just dab at the area repeatedly to soak up the blood and then take a good look at the cut.
If the cut is technically just a scrape, or the cut is very shallow, clean the wound with hydrogen peroxide, apply an antibiotic ointment, and slap a Band-Aid on it. You should change this 1-2 times a day, and more often if your child gets it dirty.
If the wound is deeper, going all the way through the skin, then you should see a doctor for surgical glue or sutures. Surgical glue works well in many cases. However, as a plastic surgeon, I find that it’s usually not applied correctly. The doctor has to make sure that the skin edges are touching, or even overlapping, to get the best results. Also, you obviously can’t use glue in areas such as the eyelid area or mouth.
Sutures, or stitches, may be used if the wound has a torn muscle or exposed bone. The doctor will use dissolving sutures to close the deeper layers of muscle and tissue and removable sutures for the top layers of skin. Removable sutures leave less scar tissue, hence a prettier scar.
ER or Urgent Care?
Parents are tempted to use urgent care or “Minute Clinics” because they are close-by, the waits are shorter, and they just want their kid to stop bleeding. However, these facilities rarely have access to ER doctors and/or plastic surgeons. The ability of an urgent care center provider to apply even surgical glue may vary wildly, and is unpredictable. You may run into providers that are uncomfortable applying surgical glue or sutures to a child.
An ER should have access to ER doctors who are trained to make simple repairs. Also, most ER’s have access to a plastic surgeon “on call”, a plastic surgeon that can be called in to do a repair that the ER doctor can’t or won’t do. But yes, the wait will be longer. Heart attacks and gunshot wounds take priority over little Johnny’s cut.
Plastic Surgeon- Yes or No?
As a father, I would always want a plastic surgeon to examine and fix my kid’s wounds. A plastic surgeon will have surgical training, and will also know how to assess wounds and to fix them in as cosmetic a fashion as possible. It’s my job to care about how scars look, so I know what to do to fix a laceration and how to care for it long-term.
But on the other hand, as a plastic surgeon, I could frankly care less about pediatric lacerations. Lemme explain.
Parents often want the “experienced” plastic surgeon to see their kid. Well lady, that’s not going to happen. Older plastic surgeons have established their cosmetic surgery practice, and are not interested in interrupting their sleep patterns to see a screaming child in the ER. This is why you’re seeing the younger surgeons.
And, in reality, the younger surgeons ARE the better choice for pediatric lacerations because after their training, they have dealt with trauma patients, complex burns, complex reconstruction, and other wounds that are much bigger, nastier, scarier, and difficult to close than a cut to the face. I felt insulted, personally, several times when parents asked me about “my experience” with pediatric lacerations. It’s like asking a professional race car driver if he is comfortable driving a Mazda stick-shift.
Short & Long-Term Follow-up
When you’re done at the ER and go home, you will be given instructions on how to take care of the wound. Depending on the wound or the doctor, you may be asked to touch nothing, or you may be asked to clean the wound and put another dressing on it on a daily basis. It’s important to follow instructions. The better the after-care, the better the scar.
After the initial healing period has passed and the skin has closed over the wound, long-term scar care should begin. Too often, people ignore scars after the sutures are out. But a scar is not fully healed for 6-12 months after sutures are removed. You should keep the scar out of the sun or wear sunscreen. You can also begin to use scar enhancing products such as silicone gel bandages, hydrocortisone and cortisone injections as necessary.
WTH? Why is the Health Insurance Bill So High? And is this why Plastic Surgeons Drive Porsches?
In general, despite what you may think, the payment for the surgeon repairing the scar is quite low. I’ve had 4 years of medical school, and 6 years of surgical training on top of that, to be awakened to fix a cut on a child who is screaming and moving. I’m glad the scar looks great, and I’m overall glad I can help people once in a while, but I don’t think a payment of $200-500 for a typical pediatric laceration is too much. When you consider 20-30 minutes to get to the hospital, 30-60 minutes to do the procedure, 20-30 minutes to get back home, loss of sleep, instructions, bonding with the parent, bedside manner and ALL follow-up visits within the next 90 days included in the cost of the surgical fee, I think you’re getting a bargain.
How much does it cost to have a plumber simply go to your house for an assessment, and do nothing? $75? And if the plumber does something, you’ll probably pay him at least $300 for a repair. Laceration repair from a REAL plastic surgeon is no different. I would expect to pay less for a non-plastic surgeon, but if you want a Rolls Royce, and not a used Hyundai, I would respectfully ask you to consider the training, level of service, and overall result, before you complain too much about the surgical fee.
Also, please remember that you’re in an ER, and there are OTHER CHARGES completely not associated with the surgeon’s fee. There may be an ER fee, medication fee, surgical supply fee, nursing fee, and God knows what else. So, overall, the bill may be high, but you may notice what the surgeon actually gets may be reasonable.
And no, I don’t have a Porsche!
As always, this is not medical advice in the sense that we have a doctor-patient relationship. You should ALWAYS see an actual doctor or nurse live, and in person, as opposed to reading stuff in the virtual world and attempting to do your own diagnoses. So, quite reading this, stop the bleeding, and take a look at the wound!