One of the things I like most about blogging is that it constantly forces me to question my assumptions. Writing so much, and reading so much, requires that I continuously go back and reassess what I think. There have been times, many of them in fact, when I have changed my mind or readjusted my biases.
So let’s talk about retail clinics. As a pediatrician, I’m supposed to hate them. You see, it’s hard to get into the whole medical home thing, and still tolerate their existence. We spend so much time in medicine talking about the doctor-patient relationship, stressing the continuity of care, that the idea of someone coming along and treating patients on the fly without any actual knowledge of them is somewhat repellent.
Not only that, but so much of what people, on both sides of the aisle, talk about to improve quality includes things like coordinated care, improved health records, better communication between specialists and primary care, etc. Almost none of these things are what retail clinics focus on. So I’ve always been a bit skeptical of how they should be promoted.
And then on Friday, my oldest child started complaining of a sore throat. My middle child also had been, but the positive predictive value of his complaints is notoriously low. I was instantly panicked. This was my first day back at work after vacation. I knew my wife was busy. How were we going to squeeze in two doctor’s visits into the middle of the day? Who was going to wait until the office opened to call and schedule them? I knew what the office was like. It would take hours.
There went the entire day.
But no! My wife said she’d just take them to the Minute Clinic to get swabbed on the way to school. They open at 8 AM. No appointments. It would take a few minutes and everyone would be on their way. Problem solved.
Huh? What happened to the medical home? What happened to continuity of care? What about the doctor-patient relationship?
It’s time to own up to the real world. It’s a sore throat. If it’s a virus, there’s really nothing to do but wait. If it’s strep throat, you want to treat it (to prevent long-term problems). But strep throat is one of the easiest things in the world to treat (Penicillin still works great!). There’s a simple and almost instantaneous test for it. And, get this, physicians are incredibly bad at diagnosing it clinically. A study found that a doctor’s guess as to whether pharyngitis is bacterial or viral is right about 50% percent of the time – no better than flipping a coin.
So this is one of those situations when, really, a mid-level practitioner is more than enough to swab the throat, make the call, and treat the disease. Plus, the minute clinic is in the pharmacy, so you can even get the antibiotics right then and there. Finally, as Austin noted last week, care at such clinics costs significantly less than a doctor’s visit and WAY less than a trip to the ED.
I’m sold. For strep throat, which accounted for 15 million patient visits in 2006 alone, retail clinics seem like a pretty good idea. While I still believe in the medical home and the importance of the doctor-patient relationship and continuity of care, I’m sure there are more examples of where they work as well.
That said, there are lots of examples where they won’t. Don’t take this as an excuse to go overboard.