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Posted by Dr. Claire McCarthy February 24, 2014 08:49 AM
As a mom, I totally get the appeal of retail-based clinics (RBC's) like Minute Clinics. You don't have to make an appointment, the wait usually isn't long, and you can pick up some Kleenex and milk on your way out. How perfect is that?
As a doctor, though, they worry me. The American Academy of Pediatrics (AAP) is worried too, and that's why they've renewed their policy statement saying that RBC's aren't the best place for children to get medical care.
When I talk to people about my concerns about RBC's, the immediate assumption is that it's about money--that we doctors don't want RBC's taking money away from us. But, honestly, that's not what I'm worried about. Here's what I'm worried about:
- I use those minor visits to update medical care and check in with families. Once we've figured out that it's an ear infection or a cold or strep throat or whatever, I take a step back and make sure there's nothing else the child needs. We go over the medication list, see if anything needs refilling. We check the immunizations. We see if they are due for any blood tests. We talk about ongoing problems, like asthma or school problems, and follow up on any visits with specialists. These visits for minor problems help me keep the overall health care on track.
- Every visit is important when it comes to building relationship. Not only do I use visits for minor things to keep health care on track, I use them to get to know people--and help them get to know me, so that they will trust me and want to tell me things when the moment comes (not at all a gimme--it takes work on my part). They are also invaluable for helping families learn how to take care of sick children--and how to prevent illness and injury.
- Sometimes a minor thing isn't so minor. That swollen knee isn't such a big deal--unless you look back and see that it's part of a pattern of swollen joints, in which case it might be arthritis. That fever is no big deal--unless the child has been having frequent fevers and isn't growing well, in which case it could be time to do some tests. That ear infection isn't a big deal either--unless you look back and see that it's one of several in the past few months, meaning it's time to see the specialist. If people go to a RBC, that context is lost. As good as the practitioner at the RBC might be, they don't have the whole record--and they don't know the child and family.
- The medical record gets fragmented. I do get faxes from RBC's (I have no way of knowing if I always get them, of course), but not in real time--and once I do get them, they get scanned into the "Outside Medical Records" section of the record (because that's what they are), not the section where people are most likely to look for ongoing problems and recent visits.
- They make it harder to build a "medical home". The ideal way to deliver health care is through a one-stop shopping model, where families can turn to their doctor for all aspects of medical care. For all the reasons above, RBC's make that tougher.
Now, clearly it's not enough for doctors to sit back and wag their fingers at RBC's. The fact that so many people go to them should be a wake-up-and-smell-the-coffee thing for doctors; obviously they are filling a need that we aren't meeting. If we want more people to come to us instead of RBC's, then we need to do more of what RBC's do: offer easy, convenient access to care.
It's human nature to get stuck in habits--and the medical profession is no different. We are used to delivering care the way we've always done it--and because patients haven't had a choice, they have done things the way that works for us. But now they have a choice--and so we need to think more about doing things the way that works for them.
That is easier for some practices than others (the practice where I work offers evening and weekend appointments--I do an evening session so my patients don't always have to miss school or work to see me). The doctors that can't offer more than they are currently offering may need to reach out to RBC's in their area and partner with them.
Partnering may be what all of us need to do, since RBC's aren't going away. At the very least, we should work to improve communication between the doctor and the RBC, so that people get better care.
Because that's the goal: good care. This isn't, or shouldn't be, about competition and money. It should be about working together to be sure that every person has good, complete and consistent medical care--because that's what keeps us healthy.
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