The Problem with Mall Docs
Like most Americans, I have grown accustomed to convenience. Though I can get cheaper gas by driving slightly out of my way home, I usually pay more at the place on the direct route. The pharmacy around the corner from my pediatrics office does brisk business from patients stopping off there immediately after appointments. For many goods and services, convenience is as good a factor as any when deciding where to go.
But not medical care.
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Over the past several years, the popularity of urgent-care (or “retail”) clinics has risen dramatically. Often located within a drug store or other large retail outlet, these clinics generally offer same-day medical evaluations for a flat fee. Many commercial insurance plans now cover these visits, and convenience seems to be a major factor in patients’ opting to avail themselves of this new option. The pharmacy chain CVS has a big market share with its MinuteClinics, Walgreens has its Healthcare Clinic (formerly Take Care Clinic), and big box stores like Target and Wal-mart increasingly offer their own similar services. As it happens, one such storefront clinic opened not so long ago right around my office.
I never want my patients using it.
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It’s not that I necessarily think my patients will get poor care per se. Looking at the qualifications of the physicians the clinic employs, it seems they’re all well enough trained (though none are pediatricians). Those patients of mine who have gone and for whom I’ve received records afterward have generally been seen for straightforward concerns and have gotten straightforward care. Visit by visit, nothing notably wrong has happened.
The problem is that good medical care is more than sick visits. It’s about knowing your patients and following their health over time.
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Recently, the American Academy of Pediatrics released a new policy statement about the use of such clinics. Unsurprisingly, they strongly recommend against them. From the AAP News (subscription required):
“Retail-based clinics lead to fragmented care, incomplete health records and a possible decrease in the quality of care, the policy states. Opportunities to identify special needs and chronic conditions also are missed when patients visit retail-based clinics for “minor conditions.” Pediatricians should use these types of visits to identify problems or the early sign of diseases and address or attend to other issues, such as family dynamics, obesity, mental health or immunization gaps. A visit to a retail clinic prevents pediatricians from those in-person opportunities, which affects a child’s overall health.”
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On the surface, it may seem as though there is nothing wrong with visiting a retail clinic for concerns about a cough or ear infection. The physical exam isn’t that complicated, and for most of the complaints the management is relatively cut and dried. Why shouldn’t parents bring their kids to the walk-in clinic around the corner?
What’s missing is the big picture. At any given medical evaluation you get no more than a snapshot. Though an ear infection may not seem like a big deal, it’s important to keep an eye on how often they’re happening and if they’re clearing appropriately. Recurrent ear infections can be a sign of a chronic condition and, for younger kids, can have a negative impact on language development.
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As a child’s primary care provider, it’s my job to be on the lookout for that kind of issue. Parents may not be aware of the implications of a seemingly minor illness, and a provider at a retail clinic is only concerned with the complaint that brought the family through the door. Even if the presenting symptoms look like a clear-cut diagnosis, if a pattern over time emerges to indicate something in need of further investigation, it’s part of the care I provide to have such things in mind. I can’t see this pattern if there are pieces missing, and a retail clinic provider isn’t in a position to look for it at all.
For our part, pediatricians must make themselves as accessible as possible. If parents perceive that they won’t be able to have their children seen in a timely manner for urgent concerns, they’re going to turn to suboptimal alternatives. It’s on us to remove the demand for convenience-based care by offering increased availability.
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But retail clinics are a band-aid, at best. Every child should be seen by a medical provider trained to recognize childhood illnesses and to support healthy growth and development. Taking your child to a walk-in clinic may seem like a good solution, but it prizes convenience over quality.
And quality is never more important than when a child’s health is involved.
Related from The Daily Beast
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