Want the best pediatric care? Stay away from the retail-based clinics

The Pediatric Insider

© 2011 Roy Benaroch, MD

They’re everywhere, all of a sudden: little medical kiosks tucked into the back of drug stores, grocery stores, and big box outlets. With names like “Minute Clinic” or “RediClinic,” they stress speedy, in-and-out service. And of course, you’re already there in the store, ready to buy whatever has been prescribed. A win-win, no?

No.

Everyone knows that if you’re looking for good, wholesome food, you ought to stay away from McWendyKing. If you want good pediatric care, you ought to stay away from these quickie retail clinics, too. They’re the “fast food” of health care providers, offering exactly what your children don’t need.

What’s “good pediatric care”? Care that looks at the whole child, the whole history, and the whole story. To do a good job I have to review the history, the growth charts, the prior blood pressures, the immunization records, and more. Good care means I’m available for every concern—not just the sore throat, but the “Oh, by the way…” worries that are often more significant than the current illness. Things like “He’s not doing so well in school,” or “I think he looks clumsy when he runs,” or “What am I going to do about these headaches every day?” Every encounter is a catch-up on problems and concerns from before, to be reviewed and updated. Children are growing and developing, and every encounter is a snapshot of their over all well-being that can only make sense if it can be placed into a continuous album. At the retail-based clinic, the encounters are just a quick toss-off: an opportunity for genuinely improving health that’s thrown away.

Good pediatric care requires good training. The retail clinics are staffed by midlevel providers who may have minimal pediatric experience. Children are not the same as adults, and without specific, ongoing, significant training in taking care of kids, those well-meaning nurses at the local QuickieCare may not have the skills to adequately assess your child.

Good health care also means keeping up with recommendations and community standards. I recently reviewed two cases of children seen from my practice who were clearly mishandled by the local ZippityDoClinic. One was a child given a vaccine he didn’t need (mom said she brought the records; and even if she didn’t, my state maintains a complete vaccine registry. If they looked, they would have seen that he didn’t need another dose of that vaccine. Did they not look, or do they not know the recommendations?) Another involved treating a urinary tract infection without doing the appropriate testing beforehand (The clinic acknowledged to me that they don’t have the facilities to do the correct test. If they can’t do it right, why are they doing it at all? Are they telling parents that they’re delivering substandard care?)

This week I spoke with the Medical Director of one of the large retail-based chains, a doctor of internal medicine without any particular pediatric experience. She made the following points:

  • “There is a shortage of 40,000 primary care physicians in the USA, and we can fill in the gaps.” While it’s true that there is a shortage of PCPs, that’s primarily a problem in medically underserved areas in rural America and inner cities. Are these retail-based clinics being built where there is the strongest need? Of course not—they’re mostly in affluent suburbs where there’s money to be made. The proliferation of these McSpeedySick places in wealthier neighborhoods will make the imbalance of health resource availability worse, not better.
  • “We are committed to the concept of the medical home.” Right now her chain of clinics is offering special cut-rate sports and camp physicals, dangling cheap rates to lure patients away from their primary care docs for their well-checks. The heart of the well-check is to review all current issues, to look at the big picture, to make sure all health-maintenance tests and immunizations are up-to-date. They can’t possibly offer that service without a thorough review of the past records. A quick physical is cheap, but it is not a fair substitute for a thorough health maintenance visit at a child’s pediatrician.

The existence of a clinic-within-a-store may have another, more underhanded dark side. When I see a patient in my office, I can make whatever suggestions I feel are in the best interest of the child—I don’t make any money off of prescriptions, or medical devices, or anything else I recommend. You can be assured that your doctor isn’t suggesting something or prescribing a medication just because he’s selling it at a profit. At the retail QuickityClinic, families get their prescriptions, march over to the pharmacy, and pay for their white baggie of pills. There’s certainly at least the potential for an odious conflict-of-interest, with increasing profits tied to prescribing more medicines, more expensive medicines, or medicines with a more-favorable markup. Do you want medical decisions being made based on profit?

There’s an old saying: you can have it good, you can have it fast, or you can have it cheap—but you can’t have all three. Retail-based clinics may offer fast care, but you can’t depend on them to offer good care for children. Your kids deserve better.

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4 Comments on “Want the best pediatric care? Stay away from the retail-based clinics”

  1. Dr. Roy Says:

    I should have also added another shortcoming of retail-based clinics: followup. If I prescribe something, and there’s some kind of reaction, you can reach me or a partner 24/7. We’re here for emergency phone calls, and we’re here for routine followup, too. From your pediatrician, care doesn’t end when you walk out the door.

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  2. Sylvia Says:

    I’ll take good and fast – I happen to have a great pediatrician who always has sick appts available, rarely leaves you with long waits and cares for his patients holistically – not just the booboo of the day. Oh and he writes a good blog too! Wish MY primary care was half as good. Thank you Dr. Roy and the rest at Pediatric Physicians.

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  3. Mark Says:

    Sadly, most of my health care encounters with pediatricians (not you!) and my own doctors have been only marginally better than what you describe from these clinics.

    1. Speed. Most doctors try to get you in and out in less than 10 minutes, with very little time for meaningful discussion.

    2. Big picture. Most doctors are very focused on solving the specific problem at hand. If you even bring up a topic other than what you said you were coming in for, they cut you off or bill you twice.

    3. Health history. My folder has gotten pretty big over the years. It would probably take a half-hour for a doctor to read through my entire medical history before our appointment, and not surprisingly, no doctor does that. The folder and computerized records have only proven useful if the doctors want to look up when a specific procedure was done, and they tend to only look if *I* remember the procedure and think it might be relevant. Pediatric files are likely to have less data than an adult’s, but I have still had problems with imperfect record-keeping on my kids’ vaccinations, and no real record-keeping on things like “that antibiotic upset my daughter’s stomach, let’s try a different one next time”. I would be a lot happier if I were in possession of my own medical files.

    4. Personalization. When you’re relatively healthy and only see the doctor once a year, they usually don’t remember you. Even if you’re sick, and need to come in more frequently than that, you often end up seeing one of the other partners in the practice for a sick visit, so there’s little sense of building up a history of interaction with your primary provider. Furthermore, if you think of any questions or follow-up concerns the second you walk out the door, those questions are intercepted by a nurse and it seems like in many cases, the doctor never even hears the concern directly.

    5. Conflict of Interest. Doctors may not get a direct kickback on the prescriptions you fill, but they certainly get courted by drug companies. Also, in my area, the doctors are all part owners in the facilities that administer X-rays, MRIs, CAT scans, etc., and unsurprisingly, they tend to request those procedures at the drop of a hat.

    I do believe that a pediatric clinic offers higher quality service than one of these “fast food clinics” you describe, but I think the difference is subtle enough that most consumers will not see it. Consequently, I predict that these quickie clinics will get a lot of business. Let’s hope that the existence of these clinics will provide competitive pressure on docs to offer health care that is more clearly superior.

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  4. Eric Barnes Says:

    Mark I think your points are many times more appropriate for the adult patient, rather than the pediatric patient. I have taken my kids to a quick clinic on a Saturday a couple of times because our usual provider is not open on weekends and I can tell that we’re not getting the same level of care that we get from our usual pediatrician.

    Our pediatrician has taken care of our children since day one and knows their histories. The couple of times I’ve taken the kids to a quick clinic, the treatment hasn’t been adequate, so we end up at our regular pediatrician’s office later that week.

    On the other hand, I have been to them and haven’t had issues as long as I’m going for something that is not complicated. Kids just seem to need more from their health care provider.

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