Regional
(2010-07-12)
Listen Now:
GREELEY, CO
(KUNC) -
How good is good when it comes to your medical care. It's a question that many are asking as more and more clinics pop up in grocery and other retail stores. KUNC commentator Dr. Marc Ringel says they may not be as bad as some would think.
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Early in my career some of my most formative experiences happened at free clinics, volunteer-staffed organizations that were long on idealism and chronically short on resources. These operations sought not just to attend to people who otherwise wouldn't get needed medical services, but to affect the hearts and minds of patients and staff well beyond what happened in the immediate clinical encounter.
One larger lesson of the free clinic experience was to recognize how smart and capable are people outside of professional circles. Collaboration was encouraged, hierarchy discouraged. Professionals and lay people worked together to provide excellent services on a shoestring.
I vividly remember an occasion where I lost sight of our collaborative ideal. I picked up the chart of a patient with a sore throat who had just been seen by a fellow free clinic volunteer, a nurse practitioner student. The student had documented that she'd asked the appropriate questions, looked at the throat and ears, listened to the lungs, and obtained a throat culture. I criticized my comrade for not having listened to the heart for a murmur that could be associated with rheumatic fever, a rare complication of strep throat, and for not having felt the abdomen for an enlarged spleen, which sometimes occurs in mononucleosis, a fairly common cause of sore throat in young people, but usually of little consequence.
When I look at that encounter, several thousand cases of pharyngitis later in my career, my critique of that patient's care was unnecessarily severe, belying the clinic's professed intention to recognize and develop the abilities of non-doctors in caring for patients. My attitude was the result of the insecurity that comes with inexperience. Thirty-four years later I am certain that my comrade did a good enough job of caring for that patient.
The question of how good is good enough has come up in the context of retail medical clinics, walk-in operations, often staffed by nurse-practitioners or physician assistants, which are found in neighborhood storefronts, shopping malls, and big-box stores. These practices are designed to address acute medical problems quickly and inexpensively. Doctors' organizations, including the American Medical Association and the American Academy of Pediatrics, have gone on record with concerns about the quality of care delivered by such businesses, arguing that medical care provided outside the context of the traditional relationship of the patient with a personal physician is not good enough.
To be sure, it's always best to get your care from a highly-skilled professional who knows you well, particularly for complex or chronic problems and for preventive measures. But, when it comes to not very serious acute problems, is the service you get in a storefront clinic good enough?
A study published last year in Annals of Internal Medicine concludes that retail clinic care is as good as and way cheaper than what you get at your doctor's office, at least when it comes to throat, ear and urinary infections. Quality of outcomes for patients with these three common problems was just as high when people were seen at a retail clinic as at a traditional physician office or an emergency room. Furthermore, the service at a retail clinic cost 30 to 40% less than at a doctor's office and 80% less than at an emergency room. The literature reports high levels of patient satisfaction with care received at retail clinics, especially in terms of the lower cost and the availability of same-day appointments.
As we proceed into the brave new world of post-healthcare reform, where there will be lots more people with health insurance but no more primary care doctors to attend to them, we're no doubt going to have to receive a greater share of outpatient medical services outside the traditional setting of the doctor's office. Retail clinics will certainly be in the mix.
We should be no worse for this change of venue, if we can keep our eye on what's good enough care. It will serve us well to remember the lesson I forgot one day in 1976, that there are plenty of ways for all sorts of people to deliver competent medical care.
© Copyright 2012, KUNC
