The Walmarting of American Medicine

Where do you go when you need to see a doctor?  For many Americans, the answer is no longer “to my family doctor.”  Patient visits to family practice doctors have been declining for years.  Many of these patients now take their medical problems to an urgent care center.  This is not always a good thing.

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Urgent care centers offer convenience.  Why make an appointment with your doctor?   Why take time off from work?  Why not just drive over to the urgent care center after work?

Convenience comes with a price.  The doctor or physician’s assistant or nurse practitioner at the urgent care center does not know you.  They may never have seen you before.  He or she does not have your medical records.  He or she may not be as well trained as your personal doctor.  Increasingly, he or she may be working for a large corporation which sees you as a cash cow and only incidentally as a patient.

It is no coincidence that Walgreen’s, Walmart, and CVS, all of which sell medical supplies and fill prescriptions, are either buying or looking to buy urgent care or similar practices.  These clinics bring customers to the store.  The customers/patients may need to buy medical supplies ordered or suggested by the store’s health care employee.  The customers/patients may need to fill prescriptions ordered by the store’s health care employee.  Where better to have all these needs met than the local big chain store?  Are you sure the store’s health care employee has your best interests at heart in making these suggestions or ordering these prescriptions?

Most troubling of all, from my perspective, is the lack of specialized training of these health care employees.  I have had a number of malpractice cases in which the urgent care practitioner misdiagnosed a problem or misunderstood the medicine and failed to recognize a medical situation for the dire emergency it was.  Serious injuries and death have resulted.

Physicians who work in emergency departments are almost always specifically trained for the demands of an emergency medicine practice.  They are trained to identify emergencies.  They usually have available to them the resources of the hospital in which the emergency department is located.  This can mean radiology and laboratory services, the ability to call a specialist, if one is needed, and the ability to have a patient admitted to the hospital, if warranted.  On the other hand, pretty much anyone with a medical license can work in an urgent care center.  They may or may not recognize a true emergency when one presents itself.  They rely greatly on the customer/patient to decide if they are really sick and to go to the emergency department, if they are.

There is not much we can do as customer/patients to reverse these trends.  Big business will do what it wants, as usual.  What we can do is be aware of what is going on.  Don’t trade the value of a personal relationship with your physician and your ability to choose a well-qualified physician for the convenience of an urgent care center without at least giving the matter some thought.  Be careful what conditions you bring to the urgent care center.  Be aware of the limitations inherent in an urgent care center.  Last of all, if it is a big box store with an urgent care center in it, remember that they are trying to sell you something at the same time as they are trying to meet your medical needs.





Posted in Doctors, health, healthy living, Hospitals, medical charts, Medical Costs, medical errors, Medical Malpractice, medical mistakes, Medical Negligence, Misdiagnosis, Pharmacies |