In the last 10 years, there has been a tremendous expansion of places where patients can receive health care.
Originally people simply called their family doctors for everything, from cuts to birthing a child.
Then in the late 20th century, the emergency room became a valuable partner for the general practitioner. As emergency rooms became overtaxed, the urgent care clinics arrived for minor problems that seemingly could not wait until the next day.
There are now retail clinics. An extended care provider, usually a nurse practitioner or a physician's assistant, can be found in drug stores, grocery stores and even general retail stores. In this setting, they now provide many acute-care services and continue to expand their services.
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All of this leads to a fundamental question: Are these retail clinics a bad thing?
They look to be a great deal for the patient. Sometimes, as physicians, we forget the mundane details patients have to face to come see us.
Retail clinics provide plenty of parking, for free. There are no steps to climb. A patient can shop while waiting, making efficient use of time. No extra trip to the pharmacy is needed to fill that prescription. There seems to be no limit to the time the clinics are open. And, most important, there is someone there who has the time to listen to patients' problems.
But as we dig deeper, there are concerns that all boil down to quality of care.
How will clinical decisions be reached? Will this be done merely by protocol or algorithm? What is the education and training of the clinic staff? Won't they be biased towards writing prescriptions, specifically antibiotics? After all, their employer owns a drug store. Will the patient's primary-care doctor be contacted in a timely fashion?
The best way to ensure quality of care comes down to one word: collaboration.
At the time of this writing, there is no formal agreement between retail clinics and physicians in Northern Kentucky. It does not have to be this way.
Johns Hopkins University has an agreement with Walgreens in Baltimore.The Cleveland Clinic is working with CVS Caremark's Minute Clinics. The University of Cincinnati has formed an agreement with Kroger's The Little Clinic. My inbox is full of letters from collaborating specialists. I do not, however, have one letter from a retail clinic provider. This needs to be remedied.
When such an agreement is formed, let us be clear about the leadership role physicians will have. The physician must be an active participant. A rubber-stamp doctor does not help the patient, will not keep global health care costs down, and will only further diminish our profession.
Physicians have criticized the retail clinic model. But we also need to examine ourselves, which is part of our great tradition. We need to ask why these models of care are successful in the first place. What does it tell us about our own practices?
Doctors often project an image of being too busy. We are too busy to listen, too busy to look and sometimes, too busy to care. In short, do we project empathy? Not important? Ask the Cleveland Clinic.
It now has an entire training program on empathy for all employees including physicians. As a result, patients perceived their care was better. Perhaps, if we did a better job letting patients know "we are there for you" they would never leave home in the first place.
Obviously, there are many questions that need to be answered. Maybe retail clinics are not such a bad thing after all.
In the meantime, the Northern Kentucky Medical Society will continue to dialogue with all parties who have an interest in the subject. Our patients are the ones who have the most to gain or lose in this matter.