Physician Heal Thyself...

Caveat - I work for a health care system.

This was in the local paper here today. I am not sure how I feel about this concept. How DO we fix the health care system? I personally don't know. But we all have our own experiences to reference on the subject. And the more experiences we have, the more we realize how broken the current set up is.
MD's here are vehemently opposed to these clinics. Yet, it is very difficult in the current environment to obtain the kind of low-level services that these clinics offer. It's frustrating and a serious issue. Don Williams, the head of the RI health services council, has an extremely valid point when he counters the doctors' opposition. For many things, patients DO know what they need. And their time is significantly wasted in traipsing all over the place in order to wait exorbitant amounts of time for the "required" service. As patients we SEE that the doctors are at odds with the insurance providers ... and that we are basically pawns in the middle.

The reason I was moved to write about this at all was the specific statement by Dr. Elizabeth Lange about halfway down the article. Dr. Lange is the VP of the RI chapter of the Academy of Pediatrics (WHY must every health care org have these insanely long names??).

In her statement against these clinics, she makes her argument about the importance of overall care and attention at every office visit. OK, whether I agree that this HAPPENS in reality or not is debatable. But her next statement just angers...
“Medicine is a relationship,” Lange said. “It is not a business transaction.”
Excuse ME? Perhaps if you started with the word "Ideally" it would be a valid statement...
But please don't use such rhetoric to brush over what the reality is in today's world.
If medicine is not a business transaction, then why are we all asked for our insurance card BEFORE anything happens when we enter the doctor's office? Why are there no more house calls?
I am just tired of political posturing and arrogant verbosity to achieve agendas.
Of COURSE this subject is about financial well being.
Will there be mistakes at these clinics? Sheer numbers indicate that there will be. Just as there are in every facet of health care. And the doctor associations (unions) will drag every one through the public media to "prove their point" about the unsafeness of clinics that exist to serve a quite viable need.

Yes, it MUST be buyer-beware. The patient MUST know that these are not MD's, and that these are a low-level clinics they're attending. ... But please stop insulting our intelligence with the superior rhetoric when we all know what this is really about. Cash & power.
But sadly, this is the type of manipulative world we now live in.

OK .. so maybe I DO know where I stand on this... I don't say I'm right about it...


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Local doctors oppose MinuteClinics coming to R.I.
01:00 AM EDT on Thursday, October 25, 2007
By Felice J. FreyerJournal Medical Writer

Customers leave a CVS Minute Clinic inside a CVS in West Hartford, Conn. MinuteClinics provide quick care for minor health problems. A nurse practitioner makes the diagnosis and writes a prescription, if needed.
The Providence Journal / Steve Szydlowski
If clinics that treat minor problems open up in local stores, one thing seems certain: people will go to them. Lots of people.
But whether that’s a good thing remains open to debate. And that debate is heating up again in Rhode Island.
Last week, the two top officials of MinuteClinic, the biggest company offering the store-based, nurse-provided care that has become popular around the country, went head-to-head with the folks who helped fight them off in Rhode Island two years ago: the doctors.
Michael C. Howe, chief executive officer, and Dr. Glen D. Nelson, chairman, made the case for MinuteClinic to the Health Department’s Primary Care Physician Advisory Committee. If the executives’ purpose was to win over the primary-care doctors, they did not succeed. But they don’t need the doctors’ approval — just a license from the Health Department — and the discussion that ensued provided a glimpse of what MinuteClinic would mean for Rhode Island.
“MinuteClinic provides access to health care seven days a week in convenient locations,” Howe explained. Typically this location is a CVS drugstore; CVS bought MinuteClinic last year.
Staffed by nurse practitioners, the clinics are open seven days a week, till 8 on weeknights. They require no appointments, and waits are brief. The nurse practitioner, guided by a checklist, diagnoses and treats a limited menu of simple health problems, such as sore throats, urinary tract infections, ear infections, and rashes, typically for $59 a visit. Most health insurers will cover these visits, and uninsured people often find them affordable.
If the problem looks serious or complicated, the patient is referred elsewhere. Otherwise, the patient gets a prescription if needed, a diagnostic record, educational materials, a bill, and a toll-free number for after-hours questions. If the patient has a primary-care provider, a record of the visit is immediately sent to that provider. If not, MinuteClinic refers the patient to a local doctor.
Dr. Elizabeth B. Lange, vice president of the Rhode Island chapter of American Academy of Pediatrics, spoke in rebuttal. No medical visit is simple, she declared. When a child has a bladder infection, for example, that could indicate anything from sexual abuse to a need for circumcision. And even if the infection is uncomplicated, these visits provide an invaluable opportunity to review the medical chart, see whether vaccines are up to date, and ask how the child is doing in school.
“Medicine is a relationship,” Lange said. “It is not a business transaction.”
She also accused MinuteClinic of “frank conflict of interest” when its nurses prescribe medications that can be purchased in the same store.
Lange acknowledged that the doctors’ objections are financial as well. The kind of quick, easy care provided at MinuteClinics is the bread and butter of primary-care practices, which in Rhode Island are reimbursed at lower rates than in most other states. Pay is so low in Rhode Island that many primary care practices report difficulty recruiting new doctors. If MinuteClinic “skims off” those services, doctors are left doing the harder, slower work that pays little, such as managing chronic illnesses or interacting with schools. “We need the reimbursement to keep our doors open,” she said.
Responding to the accusation of conflict of interest, Nelson, the MinuteClinic chairman, said that MinuteClinic has documented that its nurse practitioners do not prescribe antibiotics when they’re not needed; in fact they do a better job at that than doctors. “Physicians overprescribe because the mother insists,” Nelson said.
Furthermore, Nelson said, doctors can’t deny that MinuteClinic fills a need. “There isn’t access to care. The primary-care system is not addressing the needs of patients,” he said. “You need to take a look at yourselves and ask ‘Is MinuteClinic the problem or is it what we’re providing?’ ”
Howe said that in other states MinuteClinics have had little financial effect on doctors. The clinics don’t compete with the doctor’s office, but serve as an adjunct to it, he said.
Doctors at the meeting said that just means more fragmentation of care, giving doctors new responsibilities while draining away their income.
MinuteClinic, said Dr. Albert J. Puerini, a Cranston family doctor, “provides something that McDonald’s and Burger King provide. Patients don’t see that. They don’t understand that’s not the way to get medical care, just like going to McDonald’s is not the way to eat.”
Donald C. Williams, the Health Department’s chief of health services regulation, told the doctors that some of their comments were “fairly paternalistic” and that patients often do know what they need. He noted that the MinuteClinic faces “no legal impediment” to opening as long as it meets the terms of a Health Department license. “There’s a demand for this service,” Williams said. “It’s not going to work to put blinders on.”
Indeed, MinuteClinic may be unstoppable. Launched in Minnesota in 2000, the company has recently been growing at an astounding rate. In the middle of last year, it had 86 clinics in 10 states; today there are 321 in 25 states, with plans to raise the number to 450 before year’s end.
Slower to get a foothold in the more heavily regulated Northeast, MinuteClinic now has 15 clinics in Connecticut. The Massachusetts Department of Public Health is considering its proposal to open 20 to 30 MinuteClinics in the Boston area. The department is first drafting regulations that may include such requirements as limiting the number of repeat visits by a patient, establishing policies to ensure the clinics “do not promote the use of services provided by the host retail location” and posting a sign alerting patients that they can fill prescriptions anywhere, not just at the host store.
MinuteClinic first approached Rhode Island regulators in 2005, seeking a license to open clinics in CVS stores in five upper-middle-class communities. But doctors raised objections, the Health Department showed reluctance to waive its requirements for sinks and toilets in the clinics, and it became clear that the regulatory process would be lengthy. MinuteClinic withdrew its application, promising to return.
The company has not yet reapplied for a Rhode Island license, and Howe would not say when that application would be filed. But his appearance at the Health Department last week suggests it will be soon.
While doctors worry about MinuteClinic, another group remains sanguine: nurses.
“This is all about power and control. This is not about access,” Donna Policastro, executive director of the Rhode Island State Nurses Association, said in a phone interview. “This is about the doctors not being in direct control of MinuteClinics. This is a nurse-driven model. I don’t think they like that.”
Policastro predicted that parents would continue to take children to their pediatricians, would use the MinuteClinic only when their doctor isn’t available, and would then go back to the doctor.
“We’re a team,” Policastro said. “This should be a team effort.”