Docnotes: MinuteClinics?

Bruce writes about MinuteClinics .. then Richard comments.

They are both right.

Quickie Clinics may threaten family physicians' business. Sure ..

But is this bad? Not necessarily. Today I saw a child with a sore throat. She lives 40 miles away. Dad called the office and asked us to refer her to an urgent care clinic near their home. The insurance rule is that we can refer to urgent care if we can't see her .. or if we are closed. But not if we are open. So we said no. She needs to come in.

So she comes in and the rapid strep is positive. As I am writing the rx for her, I ask her if she has any allergies to medication. She says "yes - Amoxicillin gives me a rash" (she's <10!) .. and dad nods. The EMR warns me of an allergy to penicillins. Everyone agrees.

So I write a prescription for something more appropriate (no -- not azithro!) and schmooze a bit with her. She tells me that "dad wants to get a new doctor -- he is mad we had to drive all the way here."

I nod and say that I understand and that it's a long drive and there are lots of doctors near your new house and I bet that there are some nice doctors there.

Then dad says "yeh - I was frustrated with the drive. But you held her in your hand when she was tiny and you have been with us all of this time - so I was grumbling during the drive down - but you walk through the door and it all falls away and then I remember why we still come here."

And of course he is talking about the connection between a physician and a family that we can't replace with wal-mart medicine - no matter how good it is.

Would she have gotten BAD care at the quickie medical clinic if there was one (and I was allowed to refer her there)? .. no .. but I bet it's more likely that she would have gotten something like azithromycin rather than something more appropriate.

Why do free-standing urgent care facilities prescribe more gatifloxacin and azithrmoycin (and antibiotics in general) than we do? Because PLEASING THE CUSTOMER is a primary focus of the visit. Yet without an established relationship and trust - quick "this will make you better" prescriptions are more likely to be the name of the game. Refusing an antibiotic for the negative rapid strep will be a challenge for these quickie clinics .. and I am much more concerned about THAT than I am about losing the business.

Another concern is how we would all coordinate care .. and how .. in the case that the kid and the dad forget about the allergy .. the minuteclinic can avoid harmful errors. Do they call us and ask for an allergy list? ugh .. this WOULD bug me. I don't want to pay my staff to be fielding phone calls like this .. while others make money on rendering the care.

Very complicated.

And this is all too new to really understand.