walkitout (walkitout) wrote,
walkitout
walkitout

doc in a box mystery

Actually, this is the retail clinics debate that is raging, which is a little different from the doc in a box which I have known and loved for lo some years now. I got my scuba physical at a doc in a box. I went in for a mono test (turned out not to be mono, but rather likely back-to-back viral colds, which is what I suspected, but when I run a low-grade fever that long, I start to wonder). I went in for a UTI. I got my blood test for the marriage license at one. I forget what else. I have had _good_ experiences at these places; they listen, they give evidence-based-care, they don't try to talk me into something I don't want to do. All in sharp contrast to my previous experience with PCPs (other than the nurse-practitioner I went to for gyn stuff for years).

One of the articles at Health Affairs is available for free:

http://content.healthaffairs.org/cgi/content/full/27/5/1299

And it's worth reading. The other one is not available for free, which is sort of a bummer, but there's some secondary coverage. A retail clinic is essentially a doc-in-a-box, only in a CVS or Wal-Mart or Walgreens or whatever. Which means there's someone there who can take blood, run a quick-strep or quick-UTI test, take your blood pressure blah blah blah _in the evening_ and _on the weekends_ as a walkin. For a reasonable amount of money, and they may even be willing to bill your insurance for you. Then, instead of having to make yet-another-trip to fill the resulting abx prescription (if you turn out to have strep or a UTI or whatever), you can just fill it at the drugstore you are already basically in and go home and be sick in peace and quiet. They'll also do immunizations; it's unclear whether they'll do travel clinic/scuba physical kind of stuff the way the doc-in-a-box does. At least some of them will do minor trauma stuff (sew up a cut or whatever). All a _huge_ win over waiting weeks for an appointment at a doctor or paying an exorbitant amount of money for the privilege of waiting hours at an ER (altho, to be fair, whenever I've gone to an ER or urgent care outpost, I've gotten swift, great care; I have Read Scandalous Articles, however).

Interestingly, in response to this new form of competition, some PCPs and hospitals have actually taken to offering walk-ins, same-day appointments (maybe _this_ is why Milford Family Practice is so cool?), clinics open on evenings and weekends, etc.

Here's what I do not understand. There are a _bunch_ of people out there flipping out about how these are horrible services. They seem to have two items wedged up their asses: (1) over prescribing of abx and possibly other drugs because they're trying to raise money for the business (the drugstore) in which they are operating and (2) not having a PCP and possibly therefore evading care that you Should Have (like cancer screenings).

I haven't ever _been_ to one of these retail clinics; I'm operating on the assumption that they run somewhat like the doc-in-a-boxes do/did. And those guys don't freaking over prescribe abx. PCPs over prescribe abx, because they don't want their regular clients pissed off at them and/or going elsewhere. No relationship = no threat. The docs working the clinic will only prescribe is they think it's justified. As for the evading screening issue, I think that's fairly bogus, given that immunizations, blood pressure and cholesterol screening are some of the common uses of these mini-clinics. The AMA has ginned up some bizarre fear about the clinic drumming up business for the pharmacy, which I think is pretty rich given how into-bed-with-each-other Big Pharma and the AMA are. You want to talk unnecessary prescribing of dangerous drugs as a fund raiser? Mini-clinics aren't where _I'd_ start.

From where I sit, these things look Great. Maybe not such a great idea if you're seeing a bunch of other doctors and don't communicate what you're already taking from elsewhere, but if you aren't regularly involved with the medical system and are just dealing with a stand-alone problem like a UTI or needing a tetanus shot for your two weeks in the wilderness, or you want to know if your killer sore throat needs abx or just some extra sleep and fluids, where's the harm? And honest, that looks like _exactly_ what's happening here.

Why is _anyone_ upset about this? I don't even see it particularly cutting into the local primary care practices business, and anything that can reduce the primary-care load on tertiary facilities _has_ to be regarded as a Good Thing, right? Is there some kind of social faux-pas that I'm missing?
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