The Medical Minute: Minute Clinics -- Is fast medicine like fast food?

August 30, 2006

By John Messmer
Penn State Family and Community Medicine
Penn State Milton S. Hershey Medical Center
Penn State College of Medicine

One thing is certain about people today -- they want convenience. Every town, borough and city has so many fast food restaurants and convenience stores that if people miss one, there's another a block away. When people are hungry, they want food now. Likewise, when they're sick, many of them want treatment now.

A call to the doctor might get a person in tomorrow or maybe next week. That may not be acceptable to someone who is sick now. Ever wonder why this happens? Over the last two decades, physicians have had to accept insurance contracts for primary care services and the insurers have reduced payments so much that in order to meet overhead, many physicians believe they need full schedules every day. The only way to fill schedules is to book return visits for chronic problems like high blood pressure and diabetes, leaving little room for in the schedule for urgent problems.

Naturally, this misses the point of primary care, but they don't teach business practices in medical school. When the market has an opening for a new business model, count on someone to fill it. That's what happened when Rick Krieger could not get his son in to his doctor for a sore throat. Figuring there had to be a simple way to be checked for Strep, he and his business partners opened the first of what would become Minute Clinics.

Today retail walk-in clinics are still a tiny fraction of the available treatment options, but their effect is being scrutinized by business, insurers and physicians. Typical clinics are found inside large retail stores, such as, Kmart or chain drug stores, such as, CVS. Staffed by nurse practitioners (NPs), they have a limited menu of conditions for which they will provide evaluation and treatment. Usually no physician is on site. The nurse practitioners have a specific protocol to follow. If the patient has something outside the accepted problems or seems to have more than a mild illness, they refer the patient to their own physician or an emergency room.

NPs are registered nurses with a master's degree in clinical nurse practice. They are qualified to evaluate patients and are licensed to prescribe a limited number of medications in many states. Most often, NPs work with physician practices or in hospitals extending the ability of the physician to treat patients. Nurse midwives and clinical nurse anesthetists are examples that have been around for many years. In these settings, the nurse practitioner can involve the physician immediately should it be necessary.

Is it a good idea to have the convenience of being seen in a relatively short time? It depends on what's wrong. If someone really wants a pizza, he or she can't stop at McDonald's. Everyone knows that. As with fast food, people have to know the menu at the retail clinic. If they stop in for wart treatment but want something for an aching back, they will have to go to their regular doctor.

The average person can tell the difference between a quarter-pounder with cheese and a whopper, but can that person tell whether their sore throat is due to an infection, acid reflux, sinusitis, a tumor or heart disease? In a retail clinic if it's not a simple problem, they must refer the patient back to his or her regular doctor. Sometimes knowing the pattern of a person's health from their medical record is the only clue that a more important problem could be occurring -- information that may not be available at the retail clinic.

Even if a person's insurance covers the cost of the retail clinic, it might not be a bargain. The primary care physician and any midlevel medical practitioners such as NPs or physicians' assistants in the physician's office will typically be able to handle 85-90 percent of a person's health needs while the retail clinics are limited to a tiny percentage of potential problems. During a visit with a family physician, general internist or pediatrician, health maintenance needs can be reviewed and updated. A long-term relationship should lead to better care.

If a retail clinic can provide walk-in evaluation and treatment for simple problems, why can't one's doctor do it? The simple answer is that expectations are much higher for physicians. When someone comes in with a red eye, the physician is expected to know if the problem is pink eye, glaucoma, allergy, trauma, an autoimmune disease, a corneal ulcer or foreign body or any other cause of a red eye. The NP in the retail clinic only has to know if it is or is not conjunctivitis. The physician needs more time. A quick diagnosis risks harm to the patient and legal troubles for the physician.

So what about convenience? What about being seen today for an illness? If they serve no other purpose, the retail clinics have shown primary care physicians the need to be more responsive to their patients' preferences. The American Academy of Family Physicians is spearheading a transformation in the way medical care is delivered, including promoting the use of same day appointments for those who want them.

Everyone should have a medical home -- a medical practice which has the responsibility over many years for helping us to achieve the highest level of health and which will be there when people have an acute problem. If one's doctor has known him or her for years, he or she may know what to do faster than someone who has never seen you. People who need an urgent evaluation should ask their doctor what to do.

In the 21st century, fast food may be what consumers want, but most of it is not very healthful. Fast medicine might not be much better for people.

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Last Updated March 19, 2009