Thursday, February 21, 2008

Dr. Wal-Mart

Dr. Rahul K. Parikh wrote an interesting essay in Salon.com arguing in favor of 'retail health clinics' in places like Wal-Mart and Target.

Many medical groups, like the American Academy of Family Practice and the American Academy of Pediatrics (to which I belong), have published position papers opposing retail clinics. Their basic argument is that retail clinics run counter to the concept of "a medical home," a place where patients receive care for any and all of their problems.

But Dr. Parikh argues that this trend will force medical doctors to innovate.

To understand why that's the case, look at the business-as-usual model of medicine. Anybody who wants to run a competent medical practice -- from the country doctor to the tertiary care hospital -- must measure success in terms of access, quality and cost. It's safe to say traditional medical practice is struggling to succeed here. Access is unpredictable for almost any practice. Most of us simply don't have the ability to provide round-the-clock care, short of the mediocre phone service of an on-call doctor or the chaotic, overcrowded emergency room. Costs keep rising and being shifted to consumers in the form of higher premiums, deductibles and co-pays.

Although it's almost impossible to infer that the mainstream medical establishment's opposition to these clinics is anchored in more than a little snobbery. Low class people shopping in low class establishments are inevitably going to be given low class care. Assembly line shopping = assembly line medical treatment.

Yet every time I visit my primary care physician in a traditional setting, I feel like I'm on an assembly line. As I'm shuffled from the desk to the waiting room to the scale to another waiting room to the examining room, I'm probably 'handled' by as many different people as work on a Prius. No one knows my name without looking at my file. I don't bother explaining in any detail what's wrong until the last person, the person that matters, gets in.

These clinics are poor substitute from what's really needed in America: universal health care. But in the interim, they offer two things that are desperately lacking in many parts of the country: access to medical professionals and at a reasonable cost.

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