Second Opinion: You Want Fries With That Healthcare?

February 1, 2007

A Florida internist on the problems with “minute clinics.”


Regarding Pamela Moore's column, “The Bigger Picture: Converted in a Minute,”  I have no argument that the system of providing care in this country needs profound change.

However, before you strain your shoulder patting yourself on the back for being such a “picky” patient, you need to realize that pinkeye is a viral disease, and antibiotics are not necessary. (I hope I am not the only physician pointing this out to you.)

What your article does clearly point out is one of the great problems with consumer-driven healthcare: You get what you want, not what you need. You were thrilled because you got what you wanted: antibiotics. You didn’t get what you needed, which was reassurance that your cold - for that is what pinkeye is, a cold virus that happens to annoy your conjunctiva in addition to giving you a runny nose - would get better on its own and that you could stop spreading it to others by adhering to strict hand-washing.

You didn’t get a thorough medical evaluation and a clinical decision based on the best available medical evidence. You got what you as a consumer were looking for: speedy service, a smile, and what you had already decided you needed.

The only thing the “minute clinic” failed to do properly was to “upsell” you something: “You want fries with those antibiotics?”

In this one instance, is it a bad thing that you were given medication you didn’t need? I guess not. You went home happy, you are giving the clinic the free advertising it sought by keeping the customer satisfied, and your cold went away in a few days, as it would have done anyway. But multiply that by 200 million American consumers, expand it to all phases of healthcare, throw in direct-to-consumer advertising, and you get antibiotic resistance, unnecessary testing, and the most expensive, least effective healthcare system in the world.

Moreover, your idea that primary-care providers could have more lucrative practices by focusing on more complex healthcare and seeing fewer patients in a more in-depth manner, though laudable, is unrealistic in both the payment structure that exists today and in the world of retail medicine. The only model that has successfully been able to accomplish that is the “concierge” model of medicine where, again, the desire to please the consumer ends up interfering with, and possibly trumping, the obligation to adhere to the standards of the science of medicine.

In most cases, less-hurried concierge physicians would have also given you antibiotics because they want to keep you happy, too, but at least they might have had the time to educate you properly.

I am not arguing against change or the existence of urgent care centers by any means. The assembly line for the production of healthcare (the traditional doctor’s office) stinks. It does not allow rapid evaluation and treatment of minor illness, which is why quick clinics exist in the first place. It does not manage chronic illness effectively, and it does not incorporate significant advances in medical science efficiently. It clearly needs to change. However, fully embracing the retail model for the delivery of healthcare will not deliver good healthcare, as your article so clearly (if inadvertently) points out.

Emmet Kenney is a general internist in Pembroke Pines, Fla.

This article originally appeared in the February 2007 issue of Physicians Practice.