Wednesday, November 28, 2012

MinuteClinics Make Me Sick

     The idea of a minute-clinic is so bad that every time I hear about one opening, I feel sick.
     Now, a new MinuteClinic has opened in Gainesville. 
     From a business standpoint, it's a great idea--for the business owner.  Leave it to a corporate entity (what a surprise!) to figure this out, by reading the minds of their future clients and playing to their wishes.  Patients are lured into the clinic by the promise of a quick fix--Americans hate to wait!  Their legitimate health concerns are quashed by bright lights, cheerful smiles and the polished surface of a medical establishment with a mall atmosphere, in the same way that concerns about one's life are erased in the fluorescent glow of garbage merchandise at Walmart.  The corporation gets rich by doing nothing.  The patient comes in, signs a release of liability, pays a fee, and gets--well, pretty much nothing of value
     Here is the link to an article about the new MinuteClinic in Gainesville:

     Here's what's wrong with the "news" (really a mini-advertisement) about the MinuteClinic:
     1.  "New Clinics fill a niche for routine healthcare." 
     What's "routine healthcare?"  And where's the "niche"?  These terms makes are just a lot of noise. 
     When a patient visits a minute-clinic with a specific complaint, is the provider going to have time in that "minute" to address the long list of other health issues that are supposed to be addressed as part of routine healthcare?  No--the patient is likely to get a bandaid.  That bandaid is probably going to be a prescription for antibiotics (most "diagnoses" will be one of the default triad--sinusitis/bronchitis/UTI--made by providers who got a license, presumably, to prescribe antibiotics).
     Moreover, every patient at a MinuteClinic will be told to go to his or her primary care provider (this is the MinuteClinic's escape from liability) for the hard work of treating underlying disease processes (that's real medicine).
     2.  "This one-stop clinic"--What's one-stop about a clinic that doesn't have x-ray, spirometry, ultrasound, bone density testing, a lab, a stress test, IV apparatus or a full set of immuizations?"   The patient who has anything that can't be "treated" with an antibiotic prescription is going to be referred out.  That's not one-stop care.
     3.  The MinuteClinic has "just about everything you'd find in a regular doctor's office:  eye chart, blood pressure cuff, strep test, and flu shots."  Wrong.  Is this a joke?  Is my clinic the only doctor's office equipped with more than the four items above?  Not to mention that a real doctor's office has a doctor.  I still think that makes a difference.  A minute-clinic, however, is staffed by someone who is playing doctor.  If you want to be treated by your someone in grade school, go to a minute-clinic.
     4.  MinuteClinics imply that fast equals good, and that medical care doesn't have to entail long waits for quality service.  But high-quality medical care takes as long as it takes for a doctor to ask a lot of relevant questions, ascertain the degree of reliability of the answers, and reduce a great deal of complex information to a set of working diagnoses and treatments.  This is never going to be fast--certainly not "in a minute."
     5.  MinuteClinics give people false reassurance about their symptoms.  "Oh, it's only a UTI," I can hear patients say--then they end up having bladder cancer.  "I just have bronchitis," is what a patient with mycobacterium avium is likely to be told, by someone who doesn't even know what mycobacterium is.
     I think Americans should do away with urgent care centers and minute-clinic establishments, instead giving patient access to antibiotics, contraceptive pills, morning-after pills, anti-inflammatories and selected other medicines over-the-counter, so they can self-treat their ailments, as they do in many foreign countries.  The overregulation of relatively safe medications has created a market for minute-clinics, where nurse-practitioners give a fale impression of providing safe and reliable medical care, when in fact all they're doing is handing out quick prescriptions for knee-jerk medications.
     Minute-clinics don't fill a niche, so much as make the jobs of primary care physicians harder by delaying patients from seeking important, comprehensive medical care when they need it, and by communicating the message that medical treatment doesn't have to be complicated.  Medical treatment is complicated, and the human body is a delicately balanced organism.  You wouldn't call a furniture-polisher to tune your Steinway, so why trust your body to a minute-clinic?
     It would be better for patients to buy what they think they need at the drugstore, after reading about their symptoms on Web-MD.  Then, when they finally decide they ought to see a doctor, let's give them the genuine article.

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