Is 'Quick' Enough?

According to Van Vleck, a member of the practice, the meeting was prompted in part by two cases that had come through the group's doors -- both involving children who had been treated at area RBCs. One had strep throat and the other sinusitis, but neither had been prescribed antibiotics as warranted, she says.

Further, she says, there was "poor follow-up." Most RBCs are quick to send visit reports to a patient's regular full-time physician, but in these cases, Van Vleck says, more than a month passed before reports reached the children's pediatricians. Such a lag time, she says, could endanger a patient and lead to serious complications.

One of Van Vleck's colleagues tried to contact a MinuteClinic supervisor to discuss the cases, but, according to Van Vleck, "we have yet to hear from him. It happened in August. It is now December."

MinuteClinic's Woodburn says he was not able to comment because he lacked specific information about the cases in question. "I would very much like to have an opportunity to talk to" the Spring Valley doctors, he says, to "make sure we didn't miss anything or make any kind of inappropriate or adverse treatment."

"When treating these two conditions, we adhere to the protocols of the American Academy of Family Physicians and the American Academy of Pediatrics," he says, "and only prescribe antibiotics when it's clinically warranted."

Although Woodburn concedes that mistakes can occur, he says data collected by MinuteClinic show an extremely low error rate in the diagnosis and treatment of strep throat. In a recent quality survey conducted in Minnesota, MinuteClinic received "a 100 percent rating" for the evaluation and treatment of strep throat, outscoring the Mayo Clinic.

Pohnert also expressed surprise at the two case reports. "We are all experienced nurse practitioners," she says, "who typically have years of nursing experience in various fields as well as training and experience in family practice. We don't lose that knowledge when we come to MinuteClinic. We bring it with us and use it every day to make good clinical decisions that are appropriate for patient care in our setting."

Pohnert says that RBC nurse practitioners and physician assistants are trained to handle the kinds of minor ailments (earaches, rashes, sore throats) they see, along with procedures such as shots and blood tests. "We have a certain number of diagnoses," she explains, "and only treat minor common family illnesses . . . that we have guidelines for."

Additionally, "a part of every MinuteClinic visit includes a medical history for each patient," she says. "What medications they are on, what allergies they have, and what significant medical history, if any, they have. We have strict guidelines that trigger an automatic 'refer out' if a patient has asthma or diabetes, or any of a number of other medical conditions, depending on the presenting concern."

Pohnert and several of the physicians interviewed for this article agree that patients with chronic illnesses or complex problems -- say, heart disease, high blood pressure or diabetes -- should go to their regular doctor rather than to a quick-stop clinic. "There are real limitations of what [RBCs] can do," Kellerman says.

Fighting Back

Pohnert foresees a time when traditional medicine will adjust to the presence of RBCs, when the clinics will be seen as partners in maintaining public health, not threats.

The clinics, she says, also will serve as an early warning system for patients who visit for some minor ailment, only to find that their blood pressure is too high or they have sugar in their urine, a possible sign of diabetes. Securing care for people who might otherwise not have known they needed it, she says, "is gratifying."