This is the 21st Century

RediClinic. MedBasic Clinic. These are just two names for in-store medical clinics that are popping up all over the place. In Wal-Mart stores, CVS, Walgreens, grocery stores. They are staffed by “practitioners” who are physician assistants or nurse practitioners. In Texas, the clinics are required to have a doctor on site only 20% of the time. These clinics are cheap. From $49 to $69 for a visit. They are walk-in. No appointment is necessary. They are utilized mainly by people of modest means and by people with no insurance. They are ill. They need attention and they either don’t have the time to sit in a waiting room or they don’t have the money that a fully credentialed and licensed “doctor” demands.

There are 800 in-store clinics nationwide in 2008. That number is expected to increase to 5,000 in 2012. But, you say, these poor people do not get the skills and knowledge of a “real” doctor. That is correct and I trust that they don’t care. Many women prefer a nurse practitioner. They say that an NP takes more time, seems more interested, is much more careful and they are invariably female. That is important to many women who do not like being handled in a perfunctory manner by any man.

We all should have seen this coming. In the United States, office visits to complementary and alternative medicine now outnumber visits to primary care physicians. What are you doing wrong? That is a sincere question. Why are people with genuine maladies avoiding traditional doctors?

Alternatives to traditional medicine now take in $40 billion a year. TV talk show hosts present riveting testimonials of clinical benefits from any of a number of “therapies.” Try out eastern breathing techniques for COPD. Are you going to criticize if they breathe easier? There is an ache, a hunger for something easier than the standard spend-your-whole-day-in-the-waiting-room medical care. This is the 21st Century. Everyone wants results, slam-bam, without waiting.

The in-store clinics are open nights and weekends. They are convenient and they are quick. Perhaps this is a very good thing for traditional doctors. Let the cough and cold and lacerated knee patients use this service. You don’t have the time for them anyway. You are so damned busy that the last thing you need is another kid with a running nose. You’ve got real medicine to practice. The average physician is liable to get a nervous twitch, she is so harried and overworked.

Some doctors whine that there has been no opportunity for triage with these new clinics. Come on. Triage is what they do. These practitioners are not stupid. If there is a need, they’ll send the patient on to you or the emergency room.

And how about some acknowledgment of the kings and queens of triage. The ones who are the most accessible and the ones who “triage” for free. The pharmacist is at the bottom of the health care funnel and has been either treating symptoms by recommending over-the-counter remedies or sending the patient on to the appropriate practitioner for decades. Access is the key. They can get the pharmacist’s attention with a well-placed shout of, “Hey you, druggist.” (We hate it and it will change) The physician is behind so many layers of “security” that it is no wonder that in-store clinics will flourish. Now pharmacists who are too busy themselves can advise a patient who needs more than Aleve for menstrual cramps to go see Betty Lou, the nurse right next door.

Wal-Mart’s first foray failed. They recently closed 23 “CheckUps” clinics in four southern states. Never fear, they will persevere. The next Wal-Mart endeavor will be called “The Clinic at Wal-Mart.” They plan on having 400 in-store clinics by 2010. The retail giant will partner with local hospitals, according to the magazine “Chain Store Age.”

We are in a time of rapid change. Plato said, “Necessity is the mother of invention.” Don’t look away, there is a whole lot of “necessity” coming up just over the horizon.