Last evening’s NBC Nightly News focused one story on the medical clinics being set up in drug stores/pharmacies, even supermarkets, across the country. CVS, Target, Walgreens, Rite-Aid — they are all doing it. Included, too, are medical sites being set up by Steve Case’s Revolution program (see previous blogs.) Even AARP has written about them.
The idea is that we health care consumers want and need quick and convenient access to medical care for easier-to-diagnose and treat problems. Instead of calling the doctor for an appointment, waiting at least hours and sometimes days, paying the high price of an office appointment (during business hours, of course!), then having to make another trip to the pharmacy for a prescription — instead we can drop in to the local drug store, sign-in, be seen and quickly tested, then pick up a prescription only feet away and be done with it. Onwards – home to rest, or back to work or school.
The professional staff is usually comprised of nurse practioners and physician assistants, sometimes MDs or ODs. That means you (or your child) will be seen by a professional who can provide a basic level of medical service, but nothing more. If the problem you have is anything more than basic, then you are referred back to your primary care physician (or perhaps a specialist? I’m not clear on that.) The nurse practioner interviewed in the NBC story also stated that all records of the visit are copied to the patient’s regular physician. And, they accept most health insurance plans, so patients pay only their co-pay, as usual.
As your friendly patient-as-healthcare-consumer advocate — I (mostly) love it! It’s helpful, consumer-friendly, inexpensive, convenient and effective.
But primary care physicians aren’t happy with the concept, and yes, I can see a few pitfalls, too.
Pitfalls from my point-of-view are these: symptoms are such squirrely things — with no patient history to review, a walk-in-quick-clinic nurse practioner might not realize that someone’s hacking cough may be something more than a bad cold. Further, one thing I emphasize frequently is the establishment of a trusting and partnering relationship with one’s doctor. It’s those occasional colds, flu and other visits that help us establish those relationships. There’s less of a chance they will develop when patients go elsewhere for the easy stuff.
Doctors don’t like it because it takes money out of their pockets. (yes — all together now! health care is not about health or care — it’s about sickness and money — remember?) They cite the fact that they have expensive offices and staffs to maintain, and that much of the work they do gets done with no way to make money from it (paperwork, phone calls, etc.) They say such clinics will be the downfall of what we know as the primary care model.
My response to that is two-fold. First — patients will always seek the quick fix. PCPs need to see the handwriting on the patient-care wall and realize that this kind of convenient service doesn’t ask them to close their doors; instead it asks them to change their business model. Why can’t they create quick clinics themselves? Or work in one of the drug-stores?
Or — even better — begin working with patients and insurance companies to shift the way they do their work. I’ve identified what I believe to be a huge hole in patient care — and I’ll blog about that tomorrow.
But for now — my advice to patients? Get the care you need in the way that makes most sense, short and long term. If your sore throat or stomach upset or whatever symptoms you have could be the result of something more difficult that a basic bug or infection, then get yourself to a doctor who will be able to see it through with you. A quick fix just won’t be the answer.
But when you or your child needs basic care for those simple-to-fix symptoms – go for it! Much better that you get that care, and get on with life, than to forego care — or languish in a doctor’s office somewhere.
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