© 2011 Roy Benaroch, MD
They’re everywhere, all of a sudden: little medical kiosks tucked into the back of drug stores, grocery stores, and big box outlets. With names like “Minute Clinic” or “RediClinic,” they stress speedy, in-and-out service. And of course, you’re already there in the store, ready to buy whatever has been prescribed. A win-win, no?
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Everyone knows that if you’re looking for good, wholesome food, you ought to stay away from McWendyKing. If you want good pediatric care, you ought to stay away from these quickie retail clinics, too. They’re the “fast food” of health care providers, offering exactly what your children don’t need.
What’s “good pediatric care”? Care that looks at the whole child, the whole history, and the whole story. To do a good job I have to review the history, the growth charts, the prior blood pressures, the immunization records, and more. Good care means I’m available for every concern—not just the sore throat, but the “Oh, by the way…” worries that are often more significant than the current illness. Things like “He’s not doing so well in school,” or “I think he looks clumsy when he runs,” or “What am I going to do about these headaches every day?” Every encounter is a catch-up on problems and concerns from before, to be reviewed and updated. Children are growing and developing, and every encounter is a snapshot of their over all well-being that can only make sense if it can be placed into a continuous album. At the retail-based clinic, the encounters are just a quick toss-off: an opportunity for genuinely improving health that’s thrown away.
Good pediatric care requires good training. The retail clinics are staffed by midlevel providers who may have minimal pediatric experience. Children are not the same as adults, and without specific, ongoing, significant training in taking care of kids, those well-meaning nurses at the local QuickieCare may not have the skills to adequately assess your child.
Good health care also means keeping up with recommendations and community standards. I recently reviewed two cases of children seen from my practice who were clearly mishandled by the local ZippityDoClinic. One was a child given a vaccine he didn’t need (mom said she brought the records; and even if she didn’t, my state maintains a complete vaccine registry. If they looked, they would have seen that he didn’t need another dose of that vaccine. Did they not look, or do they not know the recommendations?) Another involved treating a urinary tract infection without doing the appropriate testing beforehand (The clinic acknowledged to me that they don’t have the facilities to do the correct test. If they can’t do it right, why are they doing it at all? Are they telling parents that they’re delivering substandard care?)
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This week I spoke with the Medical Director of one of the large retail-based chains, a doctor of internal medicine without any particular pediatric experience. She made the following points:
§ “There is a shortage of 40,000 primary care physicians in the USA, and we can fill in the gaps.” While it’s true that there is a shortage of PCPs, that’s primarily a problem in medically underserved areas in rural America and inner cities. Are these retail-based clinics being built where there is the strongest need? Of course not—they’re mostly in affluent suburbs where there’s money to be made. The proliferation of these McSpeedySick places in wealthier neighborhoods will make the imbalance of health resource availability worse, not better.
§ “We are committed to the concept of the medical home.” Right now her chain of clinics is offering special cut-rate sports and camp physicals, dangling cheap rates to lure patients away from their primary care docs for their well-checks. The heart of the well-check is to review all current issues, to look at the big picture, to make sure all health-maintenance tests and immunizations are up-to-date. They can’t possibly offer that service without a thorough review of the past records. A quick physical is cheap, but it is not a fair substitute for a thorough health maintenance visit at a child’s pediatrician.
The existence of a clinic-within-a-store may have another, more underhanded dark side. When I see a patient in my office, I can make whatever suggestions I feel are in the best interest of the child—I don’t make any money off of prescriptions, or medical devices, or anything else I recommend. You can be assured that your doctor isn’t suggesting something or prescribing a medication just because he’s selling it at a profit. At the retail QuickityClinic, families get their prescriptions, march over to the pharmacy, and pay for their white baggie of pills. There’s certainly at least the potential for an odious conflict-of-interest, with increasing profits tied to prescribing more medicines, more expensive medicines, or medicines with a more-favorable markup. Do you want medical decisions being made based on profit?
There’s an old saying: you can have it good, you can have it fast, or you can have it cheap—but you can’t have all three. Retail-based clinics may offer fast care, but you can’t depend on them to offer good care for children. Your kids deserve better.