Is 'Quick' Enough?

At the MinuteClinic inside a CVS pharmacy in Potomac, Rachel Herman, 6, checks in with nurse practitioner Anne Pohnert. Rachel's sore throat is typical of problems seen at retail-based clinics, which are gaining in popularity.
At the MinuteClinic inside a CVS pharmacy in Potomac, Rachel Herman, 6, checks in with nurse practitioner Anne Pohnert. Rachel's sore throat is typical of problems seen at retail-based clinics, which are gaining in popularity. (By Preston Keres -- The Washington Post)
By Ranit Mishori
Special to The Washington Post
Tuesday, January 16, 2007

Some of the newest players in health care are rubbing doctors the wrong way.

You may know them: those small clinics at your neighborhood Wal-Mart, Target or CVS that promise quick attention for routine visits -- sore throats, minor aches and pains, flu shots -- with no appointments needed. The clinics, which go by such names as MinuteClinic, RediClinic, QuickClinic, Medpoint Express, Curaquick and MediMin, offer convenience and low price -- scarce commodities in today's medical marketplace. But while consumers are taking to the concept, physician resistance is building.

"The quickest, most convenient medical care is not always the best," says Caroline Van Vleck, a Washington pediatrician. Particularly, she and a growing chorus of primary care physicians contend, when it comes to children.

But even as many doctors sound the alarm, others are scrambling to adapt. Increasingly, the discussion among physicians like me is focusing on how to compete with the new clinics -- even if that means stealing a trick or two.

Not that many are convinced this trend is good for patients. Within the past six months, the American Medical Association and the American Academy of Pediatrics have both decried it.

"Convenience is not enough," the AMA lamented in a recent editorial. Comparing the mini-clinic phenomenon to kudzu -- the tree-strangling vine rampant in the South -- the AMA complained these new services are spreading too far, too fast. In a policy statement issued this fall, the AAP "opposes retail-based clinics as an appropriate source of medical care for infants, children, and adolescents and strongly discourages their use."

As traditional medicine sees it, when a young patient gets hurry-up treatment for a single symptom at a retail-based clinic (RBC), also known as a convenient care clinic (CCC), the process leads to "fragmentation of care."

Physicians such as Robert Corwin, who recently served as a director of the AAP, worry about a child's receiving medical care at different places by different providers -- most retail clinics are staffed by nurse practitioners and physician assistants, not doctors -- who may not communicate with one another.

Children, he argues, need a "medical home" -- a place offering comprehensive, family-centered, coordinated, continuous care, in which a doctor knows the patient over time.

"Parents may say, 'It's just a sore throat,' " explains Corwin, a practicing pediatrician in Rochester, N.Y. But those sore throat visits, he says, are a pediatrician's "vehicle to continue developing the relationship with the family."

Van Vleck agrees: "When I see a kid for a sore throat, I get to go through their chart. If they have a little bit of scoliosis I might check their spine. I will check their immunization record. We go over the record, and we try to go over what's going on besides the sore throat, or besides the ear infection."

Bottom line, Corwin says: "These [clinics] are not appropriate for children."


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