Walgreens moves into primary care, and it’s our own damn fault

Walgreens moves into primary care, and its our own damn fault

Will your next primary care appointment be at a drugstore?

Yes, if Walgreens can help it.

It was recently announced that the drug chain will have its nurse practitioners and physician assistants begin to diagnose and manage chronic conditions, such as hypertension and diabetes.

“We’re not trying to take over primary care, but we think we can help support physicians and transform the way care is delivered to provide more access points at a time when people need it the most,” said Heather Helle, a division vice president at Walgreens.

Family physicians didn’t welcome the idea, with American Academy of Family Physicians president Jeffrey Cain saying, “It ends up being riskier for patients and costlier for the country.”

The American College of Physicians’ Steven Weinberger was more cautious: “We need to figure out how the patient can be best served … in terms of safety, access, and communication with the primary care physicians.”

Is this good for patients? Well, yes and no.

While access would improve for patients, having multiple primary care providers, in addition to the various specialists some see, will only add to fragmented care.

If a Walgreens provider changes a medication dose, will the patient’s primary care doctor be sure to get it? Already, electronic records of hospitals within blocks of each other cannot speak to one another. WIll the Walgreen’s record be seamlessly integrated into the patient’s primary electronic record? Or will it simply be faxed over, adding to the burdensome paperwork that primary care doctors already face?

And if patients really use Walgreens for primary care, it’s certainly no guarantee they will see the same provider for each visit.

But I don’t blame Walgreens. Their motive is clear. Chronic care patients require continuing prescriptions, which they can then conveniently fill at the pharmacy a few aisles over.

I blame primary care, or more specifically, the policies that have driven primary care to near-extinction. Drugstores capitalize on the primary care shortage to obtain patients who don’t want to wait months to see a doctor. And they can provide care outside of business hours.

I also blame some of our primary care leaders who have vilified drugstore clinics as the competition, rather than acknowledging that they fill a need.

Instead of seeing Walgreens as competition, primary care doctors should partner with them and use the drugstore clinic as another access point into the health system. Competition would then be averted, continuity of care would be preserved, and patients would have improved access and their medical records seamlessly reconciled among their various care venues.

Walgreens moves into primary care, and its our own damn faultKevin Pho is co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • John Henry

    There is more profit in selling drugs to the chronically ill than in providing medical care. Walgreens have seen this is true. They are getting the lowest cost provider that can write prescriptions to provide the services. And you can bet that whenever it benefits Walgreens, the drug reps will be detailing those prescribing nurses, covering their activity as a retailer call. This is hardly a public service; this is a blatant effort to capture prescription business.And don’t worry, those nurses will write for plenty of generics. The margins are better on generics anyway. Oh, if you want to take your prescription and go to Wal Mart to fill it? You will be allowed to, but I suspect you will have to stand in line at the pharmacy counter to collect it.

    • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

      People who have been getting prescriptions filled since even before this news still have to stand in a line at the pharmacy counter to wait to collect it.

      • John Henry

        They will likely have to stand on line to collect the written prescription, which will be paperless unless a print is requested. I was not referring to the dispensed drug.

        • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

          Again, we already have that issue even at doctor’s offices now when it comes to prescriptions.

          • John Henry

            How so? The doctor is not also the pharmacist. The electronified prescription can be sent to any pharmacy the patient chooses or printed and given to the patient (or both, in certain cases.)

          • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

            Well, in a situation like when my relative that had been in the hospital got discharged we had to stop by the office to get a paper prescription for her. Even though they could have called in the medication to her pharmacy or done it electronically that’s not what happened. I had to sit around for a bit waiting for the prescription so that we could take it to the pharmacy. As for the E-script being sent to any pharmacy the patient chooses that’s not always the case. Not all pharmacies have the capability for E-prescribing yet.

          • querywoman

            Last year I had pneumonia. The hospital I was in was large, but medium size for our city. no pharmacy! I wanted hospital to have pharmacy.
            My minister took me home and we went to CVS.

          • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

            My relative uses CVS also, but we still had to go by the doctor’s office to get the prescription instead of them sending it over electronically or calling it in. And yes, my relative had pneumonia too.

          • querywoman

            My current internist is very, very good. She’s a gentle Asian woman. When I found out I was being discharged rather late afternoon on Friday, I fretted about how I had hoped to contact a home delivery pharmacy.
            She suggested that she fax the scrips to a nearby pharmacy and that when the “parson” picked me up, he could take me. That’s what we did.
            She was thrilled to meet my minister in the hospital, as she knew I had very little immediate family left.
            He’s pastored a church near her hospital for many years but had not actually been to it much. He was quite impressed with her, also, and the hospital.

        • Suzi Q 38

          Sure, they can try, but the patient doesn’t have to go that route. They can request a paper prescription, and go to a cheaper pr preferred pharmacist.

          • John Henry

            But only the most determined will do this, especially as they grab a couple of other items to buy on their way to the pharmacy counter and if they do not already know whether buying elsewhere will save them anything on the prescription price. The stores know they hold the advantage of convenience in that the patient has to travel somewhere else and wait for their prescription if they don’t buy it at the pharmacy they are already in. Add a loyalty card to the mix and the sale is most likely made right there. These stores know very well what they are doing.

    • Suzi Q 38

      Most of the drug reps are gone.
      They were laid off and they had to find other jobs.

  • http://womanfoodshinyobjects.wordpress.com/ Brian Stephens MD

    its only a matter of time before the drugstore giants start making it “more difficult” for outside doctors to order medications for patients at the same time streamlining (and maybe even reducing the cost) of medications prescribed from their own midlevel providers.
    giving patients even more reasons “not to fool with” a primary doctor.

    Walgreens would love nothing more than to control provider and pharmacist in one nice little (extremely profitable) package.

    • querywoman

      This sounds like a reasonable prediction!

    • John Henry

      No. The drugstore sees its profit in sales, and not in clinical activity. They won’t do anything to prevent patients coming in with prescriptions from their doctor. Why would they ever want to do that? They will of course want to make it easier for patients to come in to have prescriptions filled.

      • Suzi Q 38

        The CVS tried to do this in my local city. It failed.
        Not enough business. They closed the service.
        I think that they called it “Minute Clinic.”
        There was a PA there.

      • Suzi Q 38

        I agree with John. Money is money. An RX is money to them. Why would they decline that?

  • http://www.facebook.com/vikas.desai.92560 Vikas Desai

    where are these places and who are these primary doctors that make patients wait months for an appointment. i think it’s overblown, either that or PMD’s need to work more efficiently. I do not believe that there is a real primary care shortage, at least in big cities, maybe in the most remote areas of this country, (northern New york, North Texas, alaska…) This shortage is being perpetuated by other entities looking to take more business and kill the PMD profession in the name of their own personal profit. How can this not be the ultimate conflict of interest?? why is it that these large corps can engage in rampant conflicts of interest.

    • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

      I have to go in to see my Primary Care Physician in order to have a problem tended to. For me to see him the appointment is not until about 2 weeks from now. I have a friend that is using the medical care system tied in with the State University here in my home State that when she needed to see her PCP back around Jan was told that she would not be able to get in until April. That is not a good thing for her. I am glad with my problem I can wait two weeks (although I am sure that my doctor would probably prefer that I did not but that’s a story for another day), but some people like my friend having to wait months is very problematic.

      • http://www.facebook.com/vikas.desai.92560 Vikas Desai

        I feel for you, what county,state is this. I am located in suffolk county NY. Our office always allows for same day appointments and almost always take walk ins as well as extended hours. If there are more private doctors available instead of getting pushed out by health systems, insurance companies and walk in centers, this sort of limited access wouldn’t happen. It’s hard to compete in an environment when the system is rigged by large corporations. I do believe that these minute clinics can help but only places where there are dire shortages where some care is better than none.

        • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

          This is in Northeastern FL. If you would like to know exactly where I can give you my e-mail in a separate post and we can talk one on one about it. I do agree with you about that the minute type clinics could be helpful in areas where there are dire shortages, however I would want them staffed by doctors. Not NPs.

          • http://www.facebook.com/people/Jason-Simpson/100001631757606 Jason Simpson

            Give me your zip code and what kind of insurance you have and I’ll find a PCP in that zip code that will see you on Monday.

          • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

            Thanks for the offer. :)

          • Suzi Q 38

            You know what? They can be.
            Just like they can put a pharmacist in a pharmacy, a doctor can operate a practice there, within the Walgreens.

        • Suzi Q 38

          You have a good attitude.
          There are no absolutes.

        • Suzi Q 38

          I agree.
          I predict that they would go out of business in our suburban cities. I saw one that closed up. There was not enough business to keep it open.

      • buzzkillersmythe

        I got you beat. My doctor left town and my new one is a nurse practitioner. And I’m a physician. Take that!

        • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

          Wow. How do you feel about getting care from the NP?

          • buzzkillerjsmith

            Had an ear problem and she took care of it. Pretty nice lady. She spent a helluva lot more time with me than I would have spent with some damn fool with a minor ear problem.

          • Suzi Q 38

            See!
            You didn’t “die,” going to a “midlevel…”

          • buzzkillerjsmith

            True, but she might die going to me.

          • Suzi Q 38

            Don’t feel bad. I had two specialists and they almost paralyzed me. i can see how that could happen.
            They don’t call if “practicing medicine” for nothing.
            I guess you save others, though.

          • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

            Good answer Suzi. :) I like that.

          • Suzi Q 38

            Thanks, Kristy.

          • querywoman

            Buzzkillerjsmith, the nurse practitioners at family planning clinics often do more thorough exams than ob/gyns. I have a thyroid problem, so some docs feel my neck.
            In a work union related situation, I had a conversation with a NP who worked in one of those clinics and she was discussing their thorough exams, including feeling the neck on all patients.. She told me she had NEVER had a doctor feel her neck.

          • buzzkillerjsmith

            OB/Gyn NPs are more thorough and spend more time with pts, no doubt. If I were a woman I’d prefer one. Our women’s health NP spends 20 minutes with pts. After after 3 I’ve run out of things to say, but I will state for the record that I have palpated a thyroid within the last year or two. Pts like her for paps, me for heart failure.
            In truth, discussing birth control options is brainrot for most docs.

            And at bottom, OB docs are surgeons. They cut people open, and most of them do it very well, thank you. I trained with OBs, male and female. Nice folks, sleep deprived. They barely stayed awake in the pap smear/STD check clinic.

            A personable NP and a competent surgeon make for a win, win, win situation for pt, NP, and doc. The only time I get involved in women’s below the waist medicine is when the NP is not in.

          • querywoman

            But, buzzkillerjsmith, in defense of you licensed docs, the family planning NP’s don’t always treat illness. My understanding is that if they find something like an ear infection, they should find the doc or refer patient to a free low-cost source.
            NP’s are allowed to treat many illnesses, though. May depend on clinic.
            I am glad you occasionally palpate a thyroid. I’m hypothyroid, never a goiter. Now diabetic too, etc.! My current endo is marvelous, but I don’t think he’s ever felt of my neck!

          • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

            Well, that’s good that the problem was taken care of. Even more glad about that she’s so nice. How many minutes did she spend with you? One of the things I hear some people say is that NPs spend more time with the patients than the actual doctor. I get all the time I need when I am with my doctors whether it’s my PCP or my specialists, but then again I don’t talk about every single concern on every visit either. Only the ones that need to be addressed at the visit and nothing more. I save the other stuff for whenever I am there the next time.

        • querywoman

          Buzzkillersmythe, whatever floats your boat! Medicine still has a certain magical, mystery quality, and the NP may be the right match for you.

        • Suzi Q 38

          See! sometimes, the physician doesn’t care.
          It is unfortunate, but it happens, in which case, you might try the NP.
          Can you treat yourself, or is that against the “doctor rules?”

          It takes me about 2-3 months to see any kind of specialist.

          i just selected a cardiologist at a teaching hospital because of his specialty, education, and related publications to my condition. I want to make sure he has an interest in my cold hands and feet, plus swelling in my right leg.
          I am concerned about peripheral artery disease. I hope it is not the case, but my PCP is stumped, same with my neurologists. It will probably take me 2 months or so to get in to see him.
          I would never just to to a Walgreens.

          • buzzkillerjsmith

            I would treat myself except that my policy is only to refer to physicians I trust.

  • Ian

    Well seeing as Minute Clinic (it’s predecssesor actually) started in 2000, I can’t say that I’m terribly surprised. That being said I think viewing them as cooperation over competition is a bit naive. There is a huge potential for the retail clinics to cherry pick non-complicated patient’s who are meeting all their goals and reap the monetary benefits from seeing these patient’s (especially if they have access to their lab data as the original post suggests).

    Ex. Oh look Mrs. Jones with the A1c of 6.0% is here for her prescriptions today. Would you like to have a check up with one of our NP’s today. Your already here and it’s cheaper than seeing your doctor.

    Ex. Mr. Smith hasn’t picked up his insulin in 6 mos. Comes to fill his prescription. Asks about being seen and is referred to his prescribing doctor who he hasn’t seen him in almost a year.

    The defense of course will be that their clinics are staffed by PA’s and NP’s and that they feel the more complicated patient’s required an MD or specialist. These clinics will just be another player jockeying for position to collect as many compliant, healthy patients as possible and push off the truly sick and needy to someone else. Yes, I’m aware many doctor’s offices do this as well (limiting medicaid etc.) How many patient’s do you think Walgreens will see that can’t afford their medication?

    All of the above being said the real danger story to primary care will be when one of the retail pharmacies establishes themselves as a Labcorp drawing station. Once that get’s integrated primary care doctors will go the way of the artisan Cobbler.

  • Mandy

    Patients are getting used to being shunted to various midlevels at their “patient-centered medical home”, and they know that if they end up in hospital it’s not going to be “their” doctor seeing to them, but a hospitalist they’ve never met before. So even though they might technically “have” a primary care doctor, it’s not like they have been allowed to establish any kind of relationship there anyway.

    So given that, what’s the real difference between a Walgreens and many primary care centers, except that Walgreens offers more customer convenience (better hours, less waiting, more locations)?

    I personally hate how fragmented and impersonal medical care has got, but as you point out, that’s not Walgreens’ fault.

    • southerndoc1

      Stay away from any practice that bills itself as a “patient-centered medical home:” it’s a dead give-away that they’re putting the bureaucracy and administrative tasks ahead of patient care.

      • Mandy

        My mom and dad’s doctor, and several others in their local area, got swallowed up by one of these. For a fairly healthy, fit couple in their 70s it has been surprisingly hard for them to find a new “stand-alone” PCP who is taking new Medicare patients. There’s one just over an hour away but that’s too far for them. So they’re stuck, and if they are I assume many others would be as well.

        • meyati

          I hate the words, “You are a special person. You count here. Never forget that.” Then they walk down the hall and forget about you-no lab work, no doctor change, no follow up with any body-anywhere. That’s in the local MD Anderson Cancer Clinic. I also hate the Nurse navigators, whose job is to cover each others’ rears, while doing nothing. I was advised to go up and have a screaming hissy fit, with the words-Lawyer-sue. I got a nice and good medical team now sans a nurse navigator.

          • Suzi Q 38

            It is sad that you have to use the “L” word at all.
            I hesitated to use it, because the doctors would not want to treat me. They only want the easy cases, not the complex ones. If there is a problem, they tend to play “hot potato” with your life. I was hoping more of “House,” or at least “columbo.” A couple of doctors that cared enough to look deeper into my problem.

            I realized that while all of them had graduated with 14 years of learning and training, they were not all created equal. My track record right now is 7 out of 9.

            The other two almost paralyzed me. The others gave me clues that something was really wrong. It took awhile to connect the dots.

            All I can say is, maybe going private is better these days.
            The teaching hospitals are big, but the one I was at did not communicate or care enough to communicate with each other about me.
            My daughter says that at her hospital in California (first tier hospital) she thinks the specialists communicate more. How so? I asked. She said through the EMR system. That is good, but do the doctors read each others notes about a particular patient that they have in common?

          • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

            The issue of treating complex cases is why a number of people who have chronic medical problems can often have a hard time establishing any kind of relationship with a Primary Care Physician. Not all Primary Care Physicians are comfortable with dealing with people who have multiple chronic medical problems.

  • southerndoc1

    “Instead of seeing Walgreens as competition, primary care doctors should partner with them and use the drugstore clinic as another access point into the health system.”
    Why do I think that this means something along the lines of the primary care doc is responsible and liable for everything done in the drugstore, but the drugstore has no responsibilities for follow-up, after hours care, following up on abnormal labs, health mainenance needs, specialist referrals, and so on?

    • Ian

      What do you think the odds are that Walgreens will sell them chips/soda/candy/cookies after their visit for diabetes and hypertension?

      • C.L.J. Murphy

        Perhaps they could turn it into a cross-promotional marketing experience. Once you’ve bought 10 packets of fried pork rinds, six-packs of coke or beer, or boxes of Krispy-Kremes, you get a docket for a free hypertension & diabetes screening and 10% off your first script.

      • querywoman

        Big deal! I often stop by the nearby Walgreen’s or CVS for a snack after I see a doc at a hospital complex!

        • Ian

          Doctors aren’t even allowed to sell things that are good for their patients (for example pediatrician a and car seats). I’m not sure how to respond that you don’t see a problem with the fact that Walgreens is supposed to manage chronic conditions with the best interests of the patient in mind right next to the aisle with all of the Easter candy on clearance. At the minimum you could grow a sense of humor and see the irony in it all.

          • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

            I see all kinds of lawsuits at all levels just waiting to happen.

          • querywoman

            Ian, I have a sense of humor and see no irony in it at all, since my hospital complex also has candy machines, etc!
            When my decease brother had an amputation, a surgeon came out and talked to my mother and me and bought a candy bar.
            I laughed a little about the candy, and the surgeon told me he’d like to eat something else, but here was nothing available!
            Candy does stay stable in a vending machine!

          • Ian

            I am not asking the pharmacies to stop selling their stuff. I’m saying it’s inappropriate for a business whose primary function is to sell consumer products to customers to have an ancillary healthcare business. I think they can sell whatever they want (assuming it’s legal) up until they decide to start providing healthcare provider directed healthcare. The presence of desserts in the cafeteria and crappy food in the vending machines of a hospital is ancillary to the hospitals primary function of treating people’s health problems (unless you are implying the majority of hospital revenues is from the cafeteria and vending machines). You could still make a case to improve those things (The Clevelad Clinic has famoustly done so). You could make a case that hospitals shouldn’t have tobacco stocks. You could also make a case that hospitals shouldn’t have outpatient pharmacies. That doesn’t change that retail pharmacies shouldn’t have healthcare providers on site. The food comment was tongue and cheek, irony, sarcasm. Let’s put the food part aside.

            You are ok with healthcare providers at retail clinics recommending treatments that they sell on site? How about recommending a glucose meter that just happens to have the highest profit margin for the pharmacy? How about recommending medications with the highest profit margin? Shoe inserts with no peer reviewed publications that show medical benefit? Why hasn’t Walgreen’s gone into the independent urgent care clinic market? I’ll answer this one for you, because they want to sell stuff to patient’s on site that is already in the store. Why is it legal for a healthcare provider at Walgreen’s to do this but not an independent physician? You are either really naïve, or trolling.

          • querywoman

            Hey Ian, all my original comment was about was being able to stop at Walgreen’s or CVS for snacks after I left the doc’s office! Not all this other stuff you are trying to put the blame on me for!
            If you feel all this volatile about this stuff, find an appropriate place to complain! I am not responsible for most of what you think is abuse, nor am I any kind of regulator.
            I normally do not buy medical support type stuff at places like the drugstore, because Medicare encourages me to buy from places that deliver! And I am diabetic!
            There are lots of absurdities in the American medical payment system. Example: If I get a glucometer through Medicare, I have to have it delivered through someone who delivers medical equipment because I am a home health care recipient. I did it once, and it’s was about $70, that’s $56 reimbursed to the seller, and $14 from me!
            Once I bought one out of my pocket from Walgreen’s for $9.99
            Last year, my glucometer croaked early, and it took Bayer forever to replace it! So, Walgreen’s was down to $5.99 on that meter. I bought one in the store for $5.99, then ordered one online for $5.99 with free shipping.
            Sometimes, I can just pick one up in my endo’s office for free! Why? Because pharmaceutical companies give them free meters hoping for the strip income!
            Medical suppliers routinely overcharge third party reiumburses because the programs exist! Just like how everyone knows you can find a cash-only person to do auto body repairs cheaper than insurance!
            Conflict of interest on Walgreen’s/clinics is a valid point, and that’s probably a legal problem for each state.

          • Suzi Q 38

            I used to get these Bayer glucometers for FREE.
            There used to be manufacturer’s coupons for $9.99.
            I would buy the coupons on the internet, then cash them in at Walgreens, CVS, and Riteaid when the glucometers went on sale. I would only pay $1.00 or less for the tax.
            I used to have about 10 of them, and kept 2 for myself and gave the others away to my doctors.
            The money for Bayer was in the test strips.
            They didn’t care that people got the glucometers for free, as long as they had to buy the test strips for $20.00 or so fo a container of 50 strips.

            This is how I found out that I was a borderline diabetic.
            I just followed the instructions a couple of mornings to test a fasting level, and my number was 112. It was over 100 fairly consistently. I told my doctor, so her ordered an A1c, and it came back 7.1 I then lost 40 pounds and my number came back down to 80 on a fasting, then 5.1 or so.

          • querywoman

            50 strips are a lot more than $20 now! You can call manufacturers now lots of time and get meters sent free!
            When Bayer was out of my defective meter, it took me a while to get a replacement, and they wanted to send me a newer one. No way, I use an Ascencia with the 10-strip wheel! I hate strip loading!
            I tossed this in to point out waste in the system and how provides, like the drugstores, are complicit with overcharges to 3rd party payers.
            The $4 medicines at so many pharmacies have put a stop to some of the bizarre fluctuating charges.

          • W.B.

            “50 strips are a lot more than $20 now!”

            You can get 50 strips for the ReliOn Prime for $9 at Wal-Mart, look it up, that’s the reason I got that meter, becuse the strips are always cheap.

          • querywoman

            W.B., Diabetes supplies are an excellent example of modern medical ripoff!
            I hate Wal-Mart, but what Wal-Mart charges is probably truer to the cost of those little bitty strips. They are just plastic with some kind of special reactive coating area!
            Private and government insurers cover most of the costs of the other strips, which are like $70 for the major brands for 50 strips! So, assume $14 from the insured and $56 from the insurer!
            I don’t watch TV, but I do know mail order deliver companies are hucking on TV for the right to deliver diabetic supplies!
            I have a Target meter for backup for times when I don’t want to mess with the insurer or if I used to much and can’t get more!
            Yeah, all the major pharmacies, like Walgreens, have their own meters with cheaper strips! than the big brands!

  • referencegirl

    “Already, electronic records of hospitals within blocks of each other cannot speak to one another. Will the Walgreen’s record be seamlessly integrated into the patient’s primary electronic record? Or will it simply be faxed over, adding to the burdensome paperwork that primary care doctors already face?”

    Whose fault is that? Seriously? A veteran in EHRs (Electronic Health Records) at my library, now retired, told me they had been working on EHRs since the 80s. Why is it that now, in an age when we can store, share, and work on documents in the cloud, we still are unable to get one patient care record shared seamlessly across organizations? This is a case I think we might not be able to blame on government. The VA has an excellent EHR program and the American Recovery and Reinvestment Act of 2009 invested heavily in a program to encourage health care providers to get their systems up and running well. I think we might be able to lay the blame of this squarely on hospital administrators who refuse to properly invest in the software or talent it would take to get a proper EHR running.

    An interesting side note – most places that have EHRs – while they cannot seem to share with health care provider offices they can share prescriptions with every drug store and pharmacy out there. It isn’t just drug stores/pharmacies placing emphases on drugs.

    • buzzkillersmythe

      The whole point of EHRs is to profit EHR vendors. If the VA horned in, profits would plummet. If EHRs could all talk to each other, why wouldn’t people simply buy the cheapest one? Profits would plummet. What kind of Commie subversive are you, anyway?

  • http://warmsocks.wordpress.com/ WarmSocks

    Given what Walgreens pharmacy employees say about the safety of their work environment, I would never fill a prescription at Walgreens.

    My family physician can usually squeeze people in same-day when needed, and it’s only a couple day’s wait for a non-urgent appointment. I’m hard-pressed to think of a situation that would make me seek any type of care at Walgreens.

    • querywoman

      I don’t do Wal-Mart for prescriptions or anything else! My nearest Wal-Mart pharmacy is infamous! I think they don’t adequately train them before they staff the pharmacies!

      • C.L.J. Murphy

        Walgreens and Wal-Mart are two different animals. Walgreens has been around for over a hundred years.

        • querywoman

          I used this space to put in my two cents about Wal-Mart! Don’t use any pharmacy for your drugs that you feel bad about!
          FYI, among other things, a Wal-Mart snotty pharmacy tech told me she couldn’t look up a doctor’s phone number.
          I bounced thru several pharmacies after firing Wal-Mart. I remember telling a Walgreen’s pharmacist about her and the doc’s phone number in his smooth pharmacist voice, “We can look it up!”

      • http://warmsocks.wordpress.com/ WarmSocks

        I’m not a fan of Wal*Mart, either, but I might think twice about paying $10 at my usual pharmacy if I knew I could get the same thing down the road for $4. I know quite a few people who are out of work, and only able to continue their BP meds because of WM’s prices.

        When I was looking for a new pharmacy, I went to a few of the pharmacies in town and interviewed the pharmacists before making my selection. I am starting to think that part of the secret anywhere is knowing their rush hours and avoiding those.

  • YoBruja

    In Mexico this type of “supermarket-drugstore” primary care had ten years of life… :( 1 dollar per consultation… it’s really sad…

    • querywoman

      Isn’t it true that the Mexican pharmacies usually have a doc attached to right scrips for the visiting US citizens?

      • YoBruja

        Not only do that the pharmacies doctors… anyway, what you mention mostly occurs in border cities, and also occurs in states with high levels of immigrant population…

  • Ian

    Walgreens is actually behind the times. Why have NPs or PAs at all. In California it might just be the unsupervised pharmacist or optometrist who is manaing the chronic health conditions. What could possibly go wrong?

    http://articles.latimes.com/2013/feb/09/local/la-me-doctors-20130210

    • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

      All kinds of things could go wrong for sure.

    • Suzi Q 38

      I go to an optometrist at Wal Mart, of all places. She is really good.
      I can see that if an NP or PA wants to lease a room at a Walmart, this could come to be.

      • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

        Seeing an optometrist at Wal-Mart (which I have done also) to get an exam for keeping eyes healthy and getting a prescription for new lenses is not the same thing. When a complicated issue with the eye comes in to play such as like with Diabetes they then refer to the Ophthalmologist for further care of the problem. Regularly treating and managing chronic conditions like said Diabetes is a whole other ballgame.

        • Suzi Q 38

          True. Good point.
          On the other hand, if I have a fever, and it is the weekend.
          I may want to go to one of these.
          Especially if I need to work on Monday.

          • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

            Hmm, interesting point. However, what if the fever was being caused by something more complex? They are going to end up telling you to go to the ER any way.

          • meyati

            And the ER will tell you to take an Ibuprofen and contact your doctor.

          • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

            Not necessarily. That’s why I said if the fever is being caused by something more complex. And if someone doesn’t have a regular Primary Care Physician to go to which is the case for many people the only place they can go to is Urgent Care if they don’t use the Health agencies provided on the State and County level for their care.

          • meyati

            You haven’t been around the urgent cares or ERs here.

          • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

            Well, I haven’t been to Urgent Care in about 10 years so that’s a good thing. I hope that I won’t need them again in the future. As I had stated in one of my other posts for the issue that I need to see my Primary Care Physician for (which as I said before I am sure my doctor would prefer that I didn’t wait but I can because it’s not urgent so am willing to wait) I had to wait two weeks. My appointment is next week. I think that for many having to wait two or three weeks to see a Primary Care Physician is pretty common nowadays. But when I talk about Urgent Care I am also talking about places like Solantic (now called Carespot Clinic). As for the ER itself for a situation like what you describe I can believe it especially after other stories I sometimes hear about patient dumping after the emergent situation is over. Now how many of those stories are true I don’t know.

          • http://www.facebook.com/astralvl Vlada Astral

            This discussion comes from the limited understanding of what NP and PA do. They can treat chronic conditions and refer patients to the specialist iof there complecations. But they can make inderendant decisions. It is not the same as nurse who needs to call doctor for prescription. If the fever caused by something complex, the NP/PA can order the same tests/imaging as the doctor would and make diagnosis and treat. There is no mistery here.

          • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

            Not everyone is going to go to an NP for care because of personal preference and liability issues. You are right that this is not a mystery, but some of us want to make sure that we get the best care for ourselves and in a safe manner. The PA doing those tests ok, that’s fine because their position is understood. They are assisting the physician not trying to be the doctor.

  • buzzkillersmith

    Blame primary care physicians? Nope. Things have come to a sorry pass, no doubt. Certainly the US is following its own model by essentially giving up on physician-centered primary care. Other western countries have not tried to follow such a model.

    As some point we all have to face the fact that our specialty is dying and might not be saved. This is not our fault but is rather a result of uncoordinated decisions made in this society by a great number of powerful groups. I would submit that the AAFP and the ACP are very weak players in this process.

    At some point we might have to put a fork in it and move on, at least until or unless American society changes its mind. In the meantime, mamas don’t let your babies grow up to be primary care docs.

    • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

      What suggestions do you have that would help make more of American society change its mind?

      • Ian

        I think Buzz is trying to say that physicians aren’t well organized. The AMA represents less than 20% of all physicians and has basically become a subsidiary of big business, government, and hospitals. Hospitals and physicians have had a longtime somewhat adversarial relationship that is intensifying (for those that don’t work for one). The big players at the table are government, big pharma, big insurance, the AMA (see above), and various other groups that don’t represent the majority of the physicians they claim to represent. Physicians, especially primary care physicians are drowning in paper work, EMR mandates, prior authorizations, and other meaningless BS that makes it harder to take care of patients. Most struggle to make it home on time for dinner, and end up doing some work from home anyway. Primary docs are disorganized, scattered, and leaderless. Unless something dramatically changes primary care is dead, or they go the concierge route. Who knows. If enough doctors start working for hospitals and get fed up with beancounter administrative decisions that hurt patient care, maybe they will unionize. Won’t that be peachy. Your primary care doctor is a unionized hospital employee.

        • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

          That’s why I asked about what suggestions he had that could possibly make American society change its mind. Interesting figures about the percentage of physicians represented by the AMA.

        • buzzkillersmythe

          You’re right that docs are not organized and that is not likely to change as cognitive and procedural docs have vastly different views on how things are going and how things should be structured in medicine. I don’t hear the orthos complaining much about income.
          Among cognitive docs we PCPs are in the worst place of all, screaming from the rafters. I think this has to do with the fact that we are also the information management centers of medicine, a hugely resource-intensive job that is completely uncompensated. Ophthalmologists neither know nor care really. Not their world, not their problem.

          But even if we could all speak with one voice, we would still be outgunned by corporate medicine, insurance companies, drug companies. Could we get pts on our side? Probably not. Most folks are confused, distracted, uninterested.

          We’re toast, at least in primary care.

          • Suzi Q 38

            This is such a shame.
            I view your specialty (FP) as complex.
            I need my primary doctor. He is so smart.
            I will say, though he tries to treat me too long.
            For example, right now, I have a swollen right leg.
            It is really swollen. I am a borderline diabetic(no meds for it) I have hypertension (I take Diovan, so controlled).
            I was complaining about tingling in hands and feet and my hands and feet being really cold, especially at night.
            My neurologist thought at first it was only diabetes or Renaud’s. It maybe related to my c spine but who knows.

            My PCP had looked at it and said that the leg was larger than my other leg.

            He was concerned about a clot or something, so I was sent to the hospital for a scan on my leg, which turned up negative. He told me to just put the leg up, rest it, and elevate it. That was two weeks ago.

            It is still the same.
            I am going to get the opinion of a cardiologist the deals with vascular conditions, just in case. It is worth a consult, just in case it is serious.

            I will always go back to my PCP and my home base.
            I will be sad when he retires, as he has helped me for all of these years without much of a problem.

            Now that i am in my later 50′s, my life health wise has gotten more complicated.

          • querywoman

            Docs used to have a powerful “union.” It was called the AMA. Now less than half the docs in this country are in it. Is it over a $1000 a year to be in the AMA now? I wouldn’t be in it.
            I have an assortment of doctors, including specialists. The only ones of mine who tend to be in the AMA are doing work beyond their local offices, research, etc., and making impacts on their impression, like my dermatologist. My derm is a very wealthy man, but nongreedy. It bugs him that so many skin docs would rather do the cosmetic stuff than treat sick people!

          • querywoman

            Perhaps there will be new regional medical “unions,” not as expensive as the AMA, with different goals. I’m not sure county medical associations are in the same vein!
            In Texas, a teacher appointment out to me that it is illegal for Texas teachers to have a “union,” so they have an “association.”

        • Suzi Q 38

          I have made similar points before.
          What are the primary docs waiting for?

      • buzzkillersmythe

        No. Things will get worse before they get better. They might never get better.

        • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

          I am sorry that you feel this way.

          • buzzkillerjsmith

            I’m not sorry you feel sorry. But then again I am a buzzkiller.

        • Suzi Q 38

          You are right. Sometimes things just don’t get better, and you can see the “writing on the wall.”
          It is hard to be so negative, but that is reality, unless you FP’s and IM’s have an “uprising.”

          It is odd that I saw on my PCP’s business card that he is a board certified oncologist, but he runs his business and a PCP. He did the opposite of what you say to do.

          He is qualified to work at a cancer hospital or oncology practice, but he chooses to be a PCP.

          • buzzkillerjsmith

            You call it negative, I call it realistic. In truth, most of us family docs are doing Ok. It’s you all who are in world of hurt. And the med students will be fine, thank you very much.

            Your onc is an outlier. I wouldn’t try to build a health system on the hope that others will follow his lead.

          • Suzi Q 38

            I am glad to hear that you family docs are doing so well. That “the sky isn’t really falling.” Yes, it will be our loss.
            What is an “outlier?”

          • buzzkillerjsmith

            An outlier is a person or thing that is way out of the ordinary. Sorry for the jargon.

          • Suzi Q 38

            Yes, he is way out of the ordinary.

            That is why I bring fruit to the office. I want him to be in a good mood and fed before he treats me. I tell him to share the fruit with the nurses. He ignores me and says “I like this..(bag of whatever I bring)” and he DOESN’T share. He tosses my gift in his office. I have to bring TWO bags of fruit next time, because he doesn’t share.

    • Suzi Q 38

      It is sad, but blaming the leaders is not the only way to look at it.
      You must blame yourselves if you haven’t fought hard enough.
      Look in the mirror at this one. The signs were coming a long time ago.

      There were so many primary docs in the 80′s. I see far less of them today. So sad. I like to rely on my primary, if he doesn’t know what to do, I go to a specialist. The specialists are so independent o each other, even at the same hospital. I guess they don’t talk to each other like they should. No time.

    • querywoman

      Blame the gimme quick society! Nah! Medicine has changed a lot from the old days of 24 hour general practitioners making house calls! If we brought that back, maybe we wouldn’t have quickee clinics.
      Calling 911 is the quickee way now!
      When people are sick, a nearby clinic is very tempting. That’s all there is to it! Well, okay, those nearby clinics will be staffed by general med type providers, regardless of the license! Maybe primary care will grow!
      I lost my noncompliant diabetic brother, who had 3 amputations, strokes, and heart attacks, and lived many years with it. His kind usually gets treated in the emergency room.
      We would have been thrilled to have him see just about any quack anywhere for routine care, but he just wouldn’t go!

      • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

        As for calling 911 is the quickest way now, that depends on what part of the State you live in. If it’s a rural area it’s not that quick. I wish it were.

        • querywoman

          Hard for me, a city person, to conceive of 911 delays in rural areas.

          • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

            Yep, it can happen especially for the people that live way out away from the city as well as areas of the country that are mountainous.

      • buzzkillerjsmith

        How ya gonna bring ‘em back? In handcuffs?

  • querywoman

    I no longer work, but in the late eighties, when the minor emergency 7 day clinics started multiplying, I had a boss tell a coworker should have taken her sick baby to a minor emergency clinic over the weekend instead of taking off work!
    FMLA protections have softened some of that, but, believe me doctors, there are still bosses who don’t want people taking off work to see a doctor!

    • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

      Which is why some experts in relation to Primary Care are thinking that having the clinics open longer hours might be helpful for situations like that. While in theory that could be a good idea, they create problems of their own.

      • querywoman

        Yeah, Kristy, I just wanted the docs here to know how employers really feel about minor emergency clinics. They do provide an important Saturday-Sunday service for semi-urgent illnesses that don’t need emergency rooms.
        If doctors were really on call 24 hours and took phone calls, it might be different. When I was 17, we moved to a new town, and I used a doctor until I was 33 who didn’t have an answering service and seldom did hospital work. He refused to answer questions about it. I’ll call him “Dr. Jerk.” A good doctor when he was in his office, but abandoned us when not in.
        The kind of docs who post here mostly seem to have more conscience.
        Dr. Jerk’s voice mail used to say, ” We are closed, blah, blah, if you have an emergency call Hospital Such-and-Such emergency room. Please do not leave a message, as it will not be recorded.”
        When minor emergency clinics developed around here, they did and still do not answer phones 24 hours.
        Once Dr. Jerk skipped town without refilling something for me, and I called Such-and-Such emergency room. The nurse said he was not supposed to be doing that, that he seldom admitted patients there, and that she would report him.
        She also told me to get out the phone book, find a doctor who was accepting new patients, and get another doctor, which I did!
        My mother and bro kept using Dr. Jerk, so I didn’t eat him out as badly as I would have liked. Eventually, he did add an answering service, which I assumed was to please his contracting insurance carriers!

        • John Henry

          Were you supposed to return to see the doctor before getting the refill? Did the doctor have a policy of not providing after-hours refills (many do and for good reasons.) Was it posted that no after-hours telephone services were offered? Just because someone has an office does not mean they have to be willing to answer telephones around the clock or return callers’ messages after hours (and don’t tell me patients are paying for the privilege, they are not.) Some doctors do so because for them it is good practice business; others do not, for the same reason.

          • querywoman

            John Henry, my complaint has a sound basis.
            This is what happened with Dr. Jerk. I had been living in another town 35 miles away and seeing another doctor, who usually gave me 500mg amoxicillin for an ear infection.
            I had quit my job and moved back in with my mother near Dr. Jerk. He prescribed 250mg amoxicillin for my ear infection.
            After a couple of days, I called Dr. Jerk and said I didn’t seem to be getting much better, and that I usually got 500mg. He said to take two and then he would get me some more.
            I doubled the med,it helped, but when when the pharmacy called for more, “the doctor wasn’t in.” I felt really lousy without it.
            I had been very sick in the other town, once landed in the hospital dehydrated after repeated ear infections.
            When he came back the next day, he got me more. The staff claimed that if the pharmacy had mentioned me by name, they would have authorized more the day he was out.
            I won’t list all of Dr. Jerk’s numbers, but this was the last straw after a long line of stuff.
            As for his normal refill policy, he didn’t put a lot of refills on meds, wanting to be called each time, but he would usually refill long-term meds on a phone call.
            He would refill my thyroid pills for 2 or 3 years without retesting it. One pharmacist suggested, on the thyroid, that if I was still seeing Dr. Jerk, he knew what signs to look out for.
            He’s old and not licensed anymore.

          • querywoman

            Also, Dr, Jerk had no real office policies, like handouts explaining policies. We just figured stuff out.

          • querywoman

            Before Dr. Jerk, the doctor I remember first I’ll call Dr. Early. I saw him from ages 3-13. My parents first called him out for a house call for my baby brother, and fondly remember him later called to check on the baby. That would have been in the late 1950s. The housecalls soon stopped.
            Dr. Early was a very good GP, but as a kid, I feared going in, because those were the days of a penicillin shot for everything. I always thought that was too much, and now we know it is. He also did a tonsillectomy on me as a kid, also passe now. It seems he was a big, pleasant guy with a somewhat strong, confident personality! Became very popular and harder to get appts with with him shortly before we left town.
            Then from ages 13-17, we lived in another town and had a GP I’ll call, “Dr. Gentle.” Really sweet guy, very good. I did not get a ton of shots with him. I do remember him at first having pregnant women in his waiting room.
            Then we moved to the town where I met, “Dr. Jerk,” who had a dynamic personality and was a pretty good guesser at how to treat mundane illnesses! Too much antibiotics, though, we know that now!
            But the way I remember Drs. Early and Gentle is that these two men would have run their offices more responsibly with 24 hour answering services! I think Drs. Early and Gentle were both very good GPs for their times.
            As a young adult, while seeing Dr. Jerk, I joined a large urban church with plenty of professionals, doctors, lawyers, etc! The doctors at church would get phone calls from their own patients while at church but I could not reach my own family doctor!
            Like I said, at age 33, I had a permanent parting of ways with Jerk, while my mother and brother kept seeing him, griping about him. Jerk didn’t approve of HMOs or Nurse Practitioners. Eventually, he started getting into the HMO and PPO networks. He also took in a nurse practitioner in his later years, and she took over his practice after I retired.
            I know have a quite gentle Asian doctor with an office in one of those buildings by a hospital. Much different. I’d already been in the hospital twice with her.
            Last year, when I had pneumonia, maybe I got to the hospital about 10 AM. I saw a family nurse practitioner, then an ER doc introduced himself, and said my own doc would be in soon.
            She came, probably on her lunch hour. I don’t know how much energy the ER doc actually spent on me, knowing she would be there soon and having other sick patients!
            She is really good. When I saw her, I told her about seeing Jerk for years and how he never had an answering service or did hospital work.
            I know have a real jewel of a doc! Sees me herself, called in a lung doctor for me. I also see several specialists at her hospital.
            She’s solo, no NP or PA, but I would not mind her taking one in.
            I think the style of a Dr. Early may come back, with an occasional house call.

          • querywoman

            Doctors Gentle and Jerk would always see us promptly when we were ill, if they were in. Doctor Early, the one I had from ages 3 to 13, had started getting hard to get appointments with by the time I was about 12.
            Today, doctor like Early might be taking in an NP or PA, or perhaps working in a practice.

          • John Henry

            Dr. Gentle, Dr. Jerk, one’s an angel, one’s a devil. Nothing like not being able to have a nuanced and balanced view of other people.

          • querywoman

            John Henry, one thing I have learned from managed care and PPO’s is not to get too attached to one doctor. Doctors are fallible humans who do make mistakes, go in and out of business, move, and die.
            Also, Dr. Jerk earned his opinion of me, and I finally took myself and money from him.
            I blasted Dr. Jerk for his unprofessional office practices. Sometimes he let too much of his coarser side show, like using cuss words in front of my younger brother, who could cuss up a storm himself, but didn’t want his doc to talk like that.
            I speak as a woman lost one brother too young due to diabetes noncompliance.My mother said he wasn’t satisfied totally with the surgeon who did his 3rd amputation. I looked at her and said, “There is no such thing as a perfect doctor.”
            As I have said in other places, we would have been satisfied if that brother would have gone to any quack in town. I think even the modern American version of a “witch doctor” would have been better than treating diabetes himself.
            As I child, I did not like to go to Dr. Early because of the constant shots. But I do remember Dr. Early as having a genial personality. I used to play with his daughter.
            I also gave Dr. Jerk his due, pointing out that he was a pretty good general doctor, and my mother and brother continued to use him, while griping him.

            Drs. Early and Gentle ran their offices professionally.

          • querywoman

            Here’s more. Of course, I remember Dr. Jerk better than Drs. Early and Gentle. I was older! And paying bills myself.
            While seeing Jerk during the last year, I was working when I could and using cash advances against a credit card to pay Cobra insurance.
            When my Cobra ran out, I switched to a public county clinic, where I had terrific doc, Dr. Publique.
            I told Publique about how Jerk had skipped out of town without refilling my med.Dr. Publique said, “Did you know it was illegal for him to do that?” Sure, I knew.

            Publique had a primary care type practice. The clinic’s phones were answered at all hours.
            I called once on a Saturday, with a nasty ear infection. The doctor covering for Publique simply told me to go to the county hospital emergency room for antibiotic!
            Wow! I knew how to do that myself without asking! But I also use that rule if really sick when clinics aren’t open, not private insurance rules!
            Sadly, Dr. Publique died shortly before age 50 of cancer! No doc can stop us all from dying!

    • Suzi Q 38

      Yes.
      Also, I think that if I have cancer or MS or whatever, I don’t want my boss breathing down my neck asking me why I need time off to see the doctor!

  • http://www.facebook.com/jakebarringtonthefirst Jake Barrington

    As a patient, I would never go to a check up at anything other than a nonprofit clinic or hospital. Never will I go to an appointment at a corporate chain.

  • Suzi Q 38

    This is not new.
    CVS has PA’s too. They call it “Minute Clinic”
    They are not kidding.

  • http://www.facebook.com/SallyAshus Robin Taylor

    All of you have missed the principal users of “Doc-in-the-Box” (as my sister calls them) services: those who have very little or NO health insurance and therefore do not have any “primary care provider” at all! When my sister had symptoms she could not ignore any longer, she found she could see the FNP at the Minute Clinic for $59, while an MD who would see her would charge her $120 for a “new patient visit” and then require a second visit before diagnosing her trouble. For someone who earns $11 an hour the choice was obvious! The REAL issue is why is there not universal access to affordable healthcare, NOT is Walgreen’s going to put private practices out of business!

    • KLP

      So now that we have Obamacare, aka the AFFORDABLE Care Act, why are Doc-In-The-Boxes looking to EXPAND…..?

      • Dana

        The ACA is going to require that everyone have health insurance (or else pay a fine), it will not guarantee universal access to health care. I still think that enough people will fall through the cracks that these “Doc-in-the-Box” setups will be in demand.

    • querywoman

      I have a Medicare home health nurse, an LVN, who is married to an RN. They have four children, a decent income, but no health insurance. They use a, “Doc in the Box.”
      These two clearly know how to choose a clinic.
      When her teenage son needed surgery for a sports energy, I told her the local church hospitals will usually do it with a deposit, like $1000. They are just over income limits for public assistance. The high school referred to a private doc, who did the surgery, with $1000 down.
      I don’t what Obomacare will do for them, less wait in a more private office perhaps?

  • Suzi Q 38

    This should get interesting.
    I guess if the NP or PA is able to work nights and weekends, just think of the patients that they could potentially get…..it would be less expensive than an emergency room for the easier cases. Some patients have to work, so it may not be as convenient to go to their doctor after 6:00 PM. This type of convenience could fill a need that the FP is not willing to fill at this time.

    Also, the pharmacy gets all of the pharmacy business rather than Walmart, Rite Aid, or CVS.
    Things are constantly changing. My pharmacist has been offering flu shots for at least a couple fo years that I know of.

    I would consider it for the short term if my doctor was not available.

    • John Henry

      For the insured patient who will have to pay either way, there exist already urgent care centers in most places as an alternative to an ED. A NP at a drugstore won’t be able to evaluate serious illnesses or even the most minor of injuries, they will have available only the most basic diagnostic equipment and at most, maybe a rapid strep test. Any other tests will likely be sent out, unless drugstores will also be offering clinical laboratory services (that would be interesting.) But for the patient who goes to the ED because they intend to pay nothing and know they will likely be seen and treated anyway (and not just screened and stabilized as required under EMTALA) the drugstore will not be their alternative, because patients at the drugstore will be charged cash up front.

      • Suzi Q 38

        Thanks for your points. They are well taken.

      • querywoman

        Most insured patients can and will continue to see a private PCP on their small copayment.

      • querywoman

        Most private insurers, like the PPOS, now have options for their insureds to call their PPO’s or whoever is answering the phone for them to authorize an urgent visit. So it’s probably true that a lot who don’t want to pay anything just go to the ED.

        • John Henry

          No, the people who have no insurance or have certain insurances are more likely to go to the emergency room. Also, if an appointment is not available, some are directed to the emergency room.

  • Elvish

    Patients seeking medical attention at a place where they sell Alcohol, Tobacco cigarettes, detergents and all kind of bad food is just the American Health Care hitting the rock bottom.
    First primary medical education of barely 4 years and now this !

    It is an insult to Medicine !

    Shame on _______ . “You blame whomever or whatever you want !”

    • Suzi Q 38

      I remember back in the day when doctors used to sell prescription medication to patients.

      They did this to make extra money.
      I had a really resourceful doctor in my territory that used to own a small pharmacy right next door to his practice.

      He was always asking me for free samples.
      I would give him a little more than usual, but he was asking if he could buy a few cases of my samples, LOL.

      I had to say…..”uh…the pharmaceutical company doesn’t give me that much…” and gracefully exit.

      The pharmacists hated doctors that did this, and they disdainfully labeled them as “dispensers.”

      I think the laws may have changed, because I certainly don’t know of any doctors that would sell me a prescription after my visit.

      My point is that things evolve and change. People and businesses will do what they can to save money or make a buck.
      I can’t fault them for that.

      It doesn’t mean that we, the general public are going to prefer that.
      I have insurance, so I vote for Kevin Pho as our first choice for primary doctor.

      • Elvish

        “My point is that things evolve and change. People and businesses will do what they can to save money or make a buck.I can’t fault them for that.”
        This is not evolution, this is a mutation.
        Society will have to fault those doctors, as this is a severe conflict of interest; you prescribe antibiotics and sell them to a patient who would not benefit from them, as in upper respiratory infections.
        I don`t know about yourself, but I fault them; if they want to be businessmen then they should do something else for a living.
        I hope you are not a doctor.

        • Suzi Q 38

          No, I am not a doctor.
          I still don’t fault them.
          Doctors do all kinds of stuff that are for the patients good and for their own good.
          I am not sure that a doctor can sell meds to a patient anymore, anyway. Maybe those days are long gone.
          I see your point. It makes sense, a doctor that wants to sell my samples also dispenses drugs that patients may or may not need.

          Not a good doctor.

          • Elvish

            I am a doctor.
            If doctors lose their integrity then they will turn into monsters. This sacred integrity is what give parents comfort to a stranger examine their young children and teenagers.

            Once you put a doctor or a someone wearing a lab coat in a place like Walgreens, then slowly, but surely, you will compromise this integrity.

            I am sorry but this has to be stopped.

          • Suzi Q 38

            You are in the position to stop it.
            You compete.
            I remember sitting in a doctor’s lounge at a hospital during the 80′s.
            The older urologist was talking about how sad it was that the younger urologists were advertising about erectile dysfunction and the like. The younger ones were “moving in” on his business. He also didn’t like the “classless” way they went about it.

            I thought about it, and realized that time moves on and change is difficult.

            You don’t have to accept, but you do have to compete, once the competition presents itself.

          • Elvish

            It is a classless and wrong.
            But the problem is both cultural and ethical.
            This Neo-capitalism is ruining everything.
            But hey, talking here won`t solve a thing.
            Enjoy it while you can.

          • Dana

            “Neo-capitalism”? What is “neo-capitalism”?

            Reply

          • Elvish

            Neo-capitalism is what our current system is; they call a free-market, but it`s not. They don`t call it a socialist, regulated market, but it is somehow for those who can afford it. If you have enough money to form a strong lobby, which is legalized bribery, then you can “freely” compete.

            If it was a free market, then everyone can show up and call themselves doctors and then the market will self-regulate, real physicians heal people, quacks kill people.

            Civilized societies regulate health care to insure safety of their own citizens, an investment in their own human capital.

            Here, nobody wants to compromise, physicians don`t want to get a pay cut to train more physician-not medical students. People don`t want to pay their share.
            The result is physicians assistants and nurse practitioners and soon DNP treating people at the same place that sells diapers and alcohol.

            The whole thing is an insult to intelligence and civilization.

            The fact that we haven`t been doing the right thing, does not mean there is no right way to do it.

          • Dana

            I see, thank you. I am familiar with the ideas of laissez-faire capitalism and crony capitalism, but had never heard the term “neo-capitalism” before.

          • Elvish

            It`s something that I use to describe the malignancy of status quo.

  • civisisus

    Psst. Hey, primary care docs. Reach in your pocket, and pull out your cellphone. You know, that thing most of you would admit you just can’t actually practice medicine any more without.

    Now, think about the critical differentiating aspect of that device (pro tip; that aspect is right there in the device’s generic name).

    Ok, for the slow kids – the cellphone’s operation is most aptly characterized as cellular. CELLULAR. It essentially proceeds from the assumption that the device – and the person wielding it – operates in a network of like devices & systems. A network that is “smart” enough to deal with continual reconfiguration of its component elements, a reconfiguration regularly instigated (“rightly” or “wrongly”) by that person wielding the cellphone.

    And it’s wildly successful.

    Now, consider that ‘cellularity’ is quite like what is coming – finally! – to health care, and to many, many other aspects of social & economic activity. The ongoing success of any health care ‘cells’ will increasingly depend on their ability to engage productively with the growing variety of other cells in the ‘system’. Any cell’s best shot at accomplishing that engagement will stem from being ‘designed’ from the outset to do it – to be engaged – as part of its core ‘functionality’.

    You may like that. You may not like that. But things are more & more like that.

    So, are you going to bleat that “everything is ruined forever”, like, say, buzzkillersmith? Or are you, as some of our society’s most intelligent & talented people, going to do something intelligent with your talents that reflects your new-found knowledge?

    • John Henry

      To someone who presumes to speak down to “the slow kids;” just what exactly is the point you are trying to make with your silly vain post?

      • civisisus

        {sigh}

        I’ll try to write slowly and in short words so you get it.

        Doctors are not the center of health care. People who need care are. Doctors need to fit what they do to what people need done. What they need done, and how what they need done can BE done, changes over time. Complaining about having to change – in this case, about having to operate as one element of a person’s care among many possible elements, and combinations of elements – is human nature. But it’s a bad plan. It leads nowhere. Learn to think and act ‘cellularly’, and to favor health care actors who do the same.

        • John Henry

          Please show me where anyone here said that doctors were the center of health care. No one has, unless you are reading that into Kevin’s post. The subject at hand is the sponsorship of mid-level practitioners, nurse practitioners, by retail chain pharmacies, and what that means for primary care practice by physicians. Kevin laments this development and explains why. You have announced your theory, albeit in a curious and off-putting way, that there is some change in the organization of medical care that is somehow supposed to resemble the development of cellular telephone and data networks and that, and I’m guessin’ here because you didn’t exactly show why, that this is some sort of natural and unstoppable process, about which it is as useless to complain as it is about the weather.

          Your analogy is not convincing. What works in digital wireless telephony does not necessarily carry over to the supposed network of human interactions required for medical care, least of all effective, intelligent, and cost effective medical care. If you have a case to show differently, I’m interested, but so far, you haven’t made one.

        • John Henry

          Oh, and spare us your tortured efforts to explain yourself. Your short words don’t make your thoughts any more lucid.

        • southerndoc1

          “Doctors are not the center of health care. People who need care are”
          Wrong again. For-profit corporations are now the center of health care.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      Compelling, but totally not what’s happening. Cells may look independent from the ground, but they are all part of one monolithic hive built by hordes of mindless drones to service some unproductive big queen somewhere inside.

    • buzzkillerjsmith

      Whiskey-drinking, magic mushrooms, and posting is a dangerous combo, civisisus.

  • Tgharr01

    I won’t see a patient that gets prescriptions from a nurse at Walgreens. Why should I have to spend my time fixing the problems caused by someone who shouldn’t even have a license to practice medicine?

    • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

      This is an example of what I was saying above about that I can see a lot of lawsuits coming.

    • Suzi Q 38

      You would be surprised.

  • Homeless

    Here we go again

    It’s ok to see a nurse practitioner at the doctors office but not ok to see one at the retail clinic.

    Continuity of care is the most important thing until it happens after hours or in an urgent situation.

    Retailers will steer patients toward profitable treatments but doctors never recommend tests and treatments that are financially beneficial.

    Market forces will force patients to have skin in the game but it’s not OK if they pick a retail clinic.

    • John Henry

      So you would be OK with a doctor practicing in the drugstore, owning stock in the chain and the companies whose products it sells, recommending one product over another that favors the store and getting a bonus based on in-store sales? If not, then why would you be OK with a differently-qualified professional doing the same? Surely you don’t think there won’t be pressure on the NPs to do exactly that. It will be made clear to them that the viability of the clinic venture rests on the overall ability of the clinical services to not only cover their costs, including the costs of rent and lost sales due to the floorspace their enterprise uses, but also all the personnel and benefits costs. They will know soon enough that it isn’t their $59 visits that is floating their boat, and only the densest will miss the message in the personal sales reports given to them on a regular interval–maybe even weekly–regarding the in-store sales from their prescriptions. The message will be very clear: “you are here to stimulate sales. Last month you generated x dollars, here is where you stand among your peers. We are setting a goal for 10% higher next month.”

      • Homeless

        I saw a doctor that owned an MRI machine and promptly recommended a scan that would have only verified what we already knew and would not have change my treatment. He claimed the competition’s MRI machine were inferior. Why is this different from a doctor or a nurse practitioner in a drug store selling me a medication I didn’t really need?

        You don’t think doctors working in medical centers have pressures to stimulate income?

        • http://onhealthtech.blogspot.com Margalit Gur-Arie

          Of course they do. See the recent Intermountain slap on the wrist http://www.modernhealthcare.com/article/20130403/NEWS/304039948
          Two wrongs don’t make a right though….
          Every time you have clinicians subservient to corporate interests, there is almost a certainty of dollar-centered care.
          This is a step in the wrong direction, not just because of the NP vs. MD thing. More here: http://onhealthtech.blogspot.com/2013/04/fast-medicine.html

          • Homeless

            The doctor I saw was in private practice with 3 other colleagues. This is not confined to corporations.

            Of course the solution would mean what?

          • ProudOkie

            Let the semi free market reign. Walgreens will help bring healthcare costs down overall. They will provide care in a cost efficient manner. Lets all watch closely for those terrible lawsuits worse than ones incurred by physicians and report back here with them.

          • John Henry

            Wishful thinking. The purpose of the in-store prescriber is to produce prescriptions and to boost same store pharmacy sales. They are skimming the easiest to treat and the quickest to be sent out the door with a–you guessed it–prescription. What they are reducing is the time spent from receiving the prescription to obtaining the prescribed drug, knowing that who gets there first is most likely to get the sale. And how much closer can you get than being inside the same shop where you pick up your medicine? If that seems like a formula for bringing healthcare costs down overall, you are a real optimist. It sounds like the backdrop for a plan for raising prescription drug prices, knowing that once a patient with chronic disease is established with a certain drugstore and its convenient prescriber, they will not likely go anywhere else or check prices elsewhere.

          • Homeless

            You really think there is that much customer loyalty? If so, the idea that the free market will bring down prices is a fallacy.

          • John Henry

            I think there is that much force of habit and that much laziness. The pharmacy chains know that too. Of course, you will also have a loyalty card for discounts to confuse the buyers.

          • Homeless

            So you’ll pay twice as much for that prescription instead of walking across the street to Walmart?

            For the insured, prices are set by the insurance company.

          • querywoman

            Re, homeless; “For the insured, prices are set by the insurance company.” After pneumonia and being seriously ill, I switched from Target to a CVS that is closer. I have discovered CVS charges my insurance about the same as what Target did.

          • Suzi Q 38

            Not really.
            We get the “sticker shock.”
            My doctor asked me why I went to the mom and pop pharmacy in my area….”convenience.”
            I also like the pharmacist. She and her husband own the pharmacy.
            I pay $10.00 on average.
            My doctor said: “Why do you go there? Walmart will charge you only $12.00 for 3 months.”
            Good point, so I tried it. I hated waiting in the lines, the employees weren’t as nice, so I went back to my regular pharmacy.

            I can do that because I see the value in her service, plus, I have a little money.

        • Suzi Q 38

          I agree. This happened to me at a local, major teaching hospital. I was floored. I did not argue, and re took them, but that taught me that maybe it was inferior, and maybe it wasn’t.
          I complained to the insurance company.

        • ProudOkie

          Exactly.

      • ProudOkie

        Hmmm…sounds suspiciously like the physicians who are all now working as employees for large health care systems, taking losses at the PC level and shunting off to where the money is. This whole conversation is the pot calling the kettle black….love the uproar over this.

        • John Henry

          Explain.

    • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

      For some people like me I would not see a Nurse Practicioner under any circumstance because of our personal preference and would rather see an actual doctor. As I said above I have used Urgent Care clinics but I was seen by a doctor. The only way I would consider using a retail clinic even in an emergency situation is if it’s run by a doctor, however, I know that’s wishful thinking. So I will stick to my wonderful Primary Care Physician even whenever it means that it may not be until 2 weeks after I schedule the appointment as will be the case when I see him in 2 weeks.

      • Suzi Q 38

        My PCP is “hungry” for my business. I can call him on Monday, and he will see me on the same day. The receptionist knows me, and so I get in whenever I want. He is probably the same with everyone else. He is just a hard worker.
        I see his office filled with patients most of the time. At 4:00, it gets kind of slow, so I get more attention.

        • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

          That’s awesome that your doctor is like that. My doctor that I have now that I am waiting 2 weeks to see for a problem I have has been taking care of me for almost a year. He helped me get some stuff taken care of for Nursing School, and since I have been in school each time I have been in he asks me about how school is. Even before I started going to Nursing School when I came in to the office for a problem that I needed to be seen urgently I saw the PA and I was leaving he saw me (I had hoped to find him earlier to wave hello to him but I didn’t get to see him at that time). Asked me how I was doing. When that happened I was still trying to decide if I wanted to make him my regular doctor, but the day he did that I knew this was the one to stay with. I am glad I did.
          Now with that said I hope you are doing a bit better than you were the last time you and I talked.

          • Suzi Q 38

            Thanks for your comments and good wishes.
            In spite of my MRI reports (which look bad), I am feeling better. I have tried not to super analyze my report because it just depresses me.

            I do feel better and stronger, so when I go in to see the surgeon in two weeks, I will hopefully get some positive news.

            In spite of all that is wrong with me, my pain is managed on 200 mg of Advil BID. Not bad. I think it is because most of the problem is in my neck. A really bad place, but not as much body pressure there.

            I just get up every day, go to work part time, and come home to rest. Then I walk for about 30 minutes a day with my husband or a friend.

            I have met so many new people this way!

            I am happy that you are going to nursing school.
            Keep up the good work!

          • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

            I am glad to hear that even in spite of the MRI report that you are doing better. I am especially glad that you are feeling stronger as well. May all go well with the surgeon when you see him in a couple of weeks. I have to agree with you about having met so many new people through this blog. :) I wish your daughter all the best with her schooling.

          • Suzi Q 38

            Thanks.
            As far as my daughter, she is doing fine.
            She goes to a UC NP school in California.
            She has a year left.

      • Homeless

        Clearly this doesn’t work very well when you need to see a doctor right away and cannot wait two weeks and the only option your doctor gives you is to see the nurse practitioner or the physicians assistant.

        • http://warmsocks.wordpress.com/ WarmSocks

          If you are established with a doctor, it shouldn’t take two weeks to be seen for an urgent matter. If it’s urgent and the doctor can’t squeeze you in, take the immediate NP appointment; the doctor will be brought into the room after the NP determines that you truly do need a physician.
          The problem is that too many people think they need to see a doctor for the common cold. Colds do not require medical attention. Fever/vomiting don’t always require a physician, either; 24-hr bugs go away just as fast if you draw the curtains and crawl into bed as they do if you drive to the dr office and spread the germs to everyone else. After doctors endure much of the “every sniffle needs a dr” mentality, it’s no wonder they employee NPs and PAs to rake in the money from people who insist on care even though they don’t need to see a doctor.
          My family physician’s NP is quite willing to admit when things are beyond her expertise and go get the doctor. Sorry if yours isn’t.

          • Homeless

            Every sniffle doesn’t need to be seen at a doctors office. Why not save $50, get seen on my schedule and go to Walgreens.

          • http://warmsocks.wordpress.com/ WarmSocks

            Sniffles don’t need to be seen anywhere. The money could be better spent on a box of kleenex or a package of hankies & a nice dinner out somewhere.

          • Homeless

            You seemed to miss the point. It doesn’t matter where the nurse practitioner practices…it’s still not a doctors’s appointment.

          • Suzi Q 38

            I agree.

        • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

          If I couldn’t see my doctor then I would have no problem with the PA, and I have done that before. But as far as the Nurse Practicioner if the clinic had other doctors in the practice like my clinic does I would schedule with either the PA or one of the other doctors. Also, depending on the situation my doctor’s MA can get me in sooner with what they call acute if that ever becomes necessary.

          • Homeless

            So you are OK if Walgreens staffs it’s clinic with PAs?

            My doctor’s office will schedule you with a mid-level if you need urgent care…not another doctor in the practice.

            If I have an urgent situation with one of my chronic conditions, I just call one of my specialists. One will squeeze me in the same day and another will problem solve over the phone until I can get an appointment.

            For simple things, I consult Dr. Google, call my nurse line for clarification, go to the urgent care staffed by nurses if needed to get a prescription or lab test. It doesn’t really matter who I see because I already know what the outcome will be..

          • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

            The clinic would still need to have a doctor on staff, and that’s who I would see when it comes to retail clinics. The PA would only be for back up just like I do now with the clinic I go to. As for the clinic you dealt with scheduling a visit for urgent care if I needed Urgent Care I would go to the Urgent Care clinic and make sure that I am seen by a doctor. I am not obligated to see a Nurse Practicioner for urgent care needs if I don’t want to and I won’t do it under any circumstance. That’s just my personal preference just like you have yours. As for the thing with Dr. Google that I would not do. When I have urgent issues with my conditions that require urgent care from my specialists they are who I call, but I will not burden them with medical problems that are outside of my condition that they are treating or their specialty. That’s ok Homeless, we each have to do what’s best for us when it comes to our health. It may not matter to you who you see regardless of the outcome as to what it will be, but it does matter to some of us even if we may know what the outcome is. I am one of those that it matters to as to who will take care of my needs in an urgent situation, and in an urgent situation with the clinic I go to it will be the PA or one of the other doctors and not the NP if I can’t see my doctor. Thank you for the interesting discussion though, and may the way that things are for you now continue to work out so well for you.

          • querywoman

            My deceased mother and I occasionally encountered doctors who just couldn’t get us in when we were sick and would maybe phone in something or offer an appointment 2 weeks anyway.. We wouldn’t use that kind. They specialize in preventive medicine.
            I expect to be seen when I am ill.
            I don’t need lectures on antibiotic abuse either. I have been a heavy antibiotic user in the past for serious ear infections and know the risks: resistance, yeast infections, etc.
            Once I neglected an ear infection, and ended up quite ill, in serious pain, and with a ruptured eardrum (that relieved the pain).
            Fortunately, I no longer get that many ear infections and don’t always need antibiotics! Everything in life has a risk, a price!

          • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

            I agree with you about everything in life having a risk as well as a price. I also know just what you mean about neglecting an infection and having it cause trouble. About 2 years ago I got a sinus infection and I let it go for some time before I got treated. I learned my lesson after that. That was one of those situations where I needed to see the PA because I couldn’t get back in with my doctor.

      • ProudOkie

        I love your honesty. I truly respect your decision and your post and would never expect you to see me.

        • Suzi Q 38

          That is nice, ProudOkie.
          I respect Kristy too.

          • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

            Thank you Suzi Q. I respect you and your opinion also.

        • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

          ProudOkie, I thank you for your response and understanding. I am very proud to be going in to Nursing (almost done with my Prerequisites and we’ll see if I get on to the next round but I have to pass the Chemistry first), but it bothers me very much to see Nurses trying to be something they are not. I am glad that your patients like you so well and the same for other patients that go to you and other NPs, but I worry about what’s going to happen when something more serious goes wrong and the suits start to happen because it was something that should have been cared for by an actual doctor. I know you have said that you refer to the doctor when necessary, and that’s good. But the reason why many States will not allow for NPs to practice independently is because of the risk of liability. Yes, I know there’s not a lot of liability now when it comes to the issue of suit for malpractice etc, and that’s good. But what happens when those numbers rise because the person should have seen the doctor in the first place?
          How many of the patients that you see truly understand that you are a Nurse and not an M.D./D.O.? The reason I ask is because a number of people don’t understand that NPs are not doctors no matter how many times you may explain that you are not. It especially causes confusion if those NPs are wearing white coats because the white coats are more known for doctors. I am glad that you like what you do and that there are those that trust you. I just worry for all of you from the legal standpoint because now the amount of responsibility that you take on is even greater. I want to be a Nurse, although at one time in my life I thought I wanted to be a doctor. I am too old for Medical School now. I am 41.

  • querywoman

    The profit motive really corrupts American healthcare! Does anyone know how profit impacts British and Canadian socialized medicine? It has to be there!

  • querywoman

    I’ll just throw this tidbit out at the readers here: today, a friend with HIV told me that Walgreen’s makes $70,000 off his meds every year. He’s on Medicare, and maybe Medicaid too.
    All businesses are about money, even the nonprofits.

  • http://twitter.com/DSN_MikeJohnsen Mike Johnsen

    This graduation from serving acute care needs to chronic care for Take Care patients didn’t happen in a vacuum. Fact is, PCPs are already hard pressed to see folks. What happens on Jan. 1, 2014 when the rest of the Affordable Care Act kicks in? 30 million patients with nowhere to go? There is and will be a need for this kind of convenience-oriented service. And it’s not designed to supplant medical homes. In fact, it’s designed to augment medical homes. More and more pharmacies are partnering with healthcare systems to maintain that continuity of care (Walgreens has partnered on three ACOs). And because of pharmacy’s convenient locations and flexible, walk-in hours are attractive to those who may not currently have a medical home, this becomes a potential first point of contact to capture those patients.

    • southerndoc1

      “More and more pharmacies are partnering with healthcare systems to maintain that continuity of care”
      No, they’re “partnering” to maximize market share.

  • meyati

    My health care plan uses Walgreen’s for flu, pneumonia, and shingles shots. Several months after the shot, I mailed a copy of the shot record to my doctor to get it in my records. I filled out my paperwork-they handed me my copy before the shot. I said, “My name is not Margaret.” It went downhill from there. It hurt, the pharmacist said it was done, so I tried to stand up. The vial was still half full and in my arm. I told him that I resented the injection not being in my line of sight. He followed me out, apologizing, and said- I’ll see U next year. I said, “I don’t think so.”

  • http://www.facebook.com/robert.luedecke Robert Luedecke

    Very brave words, Dr. Pho!

  • querywoman

    Memories of the way life used to be in pharmacies: when I was 3-13 and lived in the town in which we saw “Dr. Early,” we used a pharmacy in his medical office building. It was very small, and the pharmacist sold little else in front of his pharmacy counter. What I’d really like to know is if those old little bitty pharmacies sold cigarettes!
    There was also a Walgreen’s. It had a lunch counter, and I do miss those, with the stuff like grilled cheese sandwiches, Coke floats, milkshakes, fries, etc. Ours also served up delightful water on ice in real glasses! I remember once going there and getting a divine water in a glass, and then we decided not to eat there.

  • Jbsilva

    This is going to be an adventure!

    • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

      It already is one.

  • querywoman

    As for what drugstores sell along side meds, the choices at a vending machiine in a building that’s part of a very major church medical complex yesterday weren’t so hot for me.
    I went to a specialist, not for my diabetes. I try to carry some food with me, but sometimes I do run out of stuff. Yesterday, a bus on my way in ran late, so I didn’t get to stop at a convenience store.
    The hospital restaurants are too far from his building for me to quickly get real food. I’ve often had blood sugar lows in his building.
    My vending choices yesterday were a Coke and juice machine, a snack with candy and chips machine, and a machine with the more expensive but yucky meat-type choices to be heated (leery of those for food poisoning).
    So my sugar was low before I saw him. I stared at the machines. Didn’t want a soft drink with sugar or juice- too much of a sugar buzz. I have to be careful of the candy and chips machine because of a peanut allergy. Peanuts won’t send me in to allergic shock, but I don’t need them.
    I wanted something starchy with some protein and sugar to keep me going. I can’t even remember what I got,but it hardly kept me going for the hour and a half it took to see him.
    The truth is those machines have products that stay shelf-stable a while.
    After I left him, I went to the hospital cafeteria for a decent meal.

    • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

      Querywoman, I know what you mean about having to be careful about the kind of candy you eat (or any kind of snack or food such as at restaurants) because like you I have a peanut allergy. I am still learning how to work with it so that I can still eat what I want. Of course, this is also a good reason for me to try and learn to eat healthier which I am working on. Unfortunately that is easier said than done.

      • querywoman

        There are a lot of peanutty things like M&Ms in snack machines. I didn’t want a stale cardboardy cheeseburger.

  • http://twitter.com/SalesMutt Beth Brown

    If the Wallgreens model does not work ( ie make money) it will not survive but other models will pop up. It is going to take a generation to move from illness to wellness and “population heatth” ( whatever that turns out to look like) and these kind of solutions are necessary to fill the treatment gaps. The key will be physicians AND nurses working together to determine what the future looks like and how to make money from it or they will be continue to find the marketplace and politicians telling them what they look like

    • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

      “The key will be physicians AND nurses working together to determine what the future looks like and how to make money from it or they will continue to find the marketplace and politicians telling them what they look like.”

      Even with that being the case, if there is a part of the public population that does not want to see Nurse Practicioners for their care because of personal preference and the liability issues then those models that will pop up will fail. Isn’t that sometimes happens with fads? That everyone follows it for a while and then when interest is lost everyone else goes on to another new fad? To which the cycle then starts again. But these new models are still not going to fix the problem of not having enough Primary Care Physicians to go around. There’s a lot more that must be done in order to fix the problem. Some people believe that NPs taking on some of the duties that come with Primary Care will help fill in the gaps until we get more doctors. Even if there weren’t the liability and personal preference aspects involved I would have to say that I don’t agree that the NPs can fill the gaps. Not all NPs will want to go in to Primary Care, and from what I have read the amount of loans that they acquire getting that education are about as high as it is to go to Medical School. Doesn’t that then put them in the same position as residents now that often choose to subspecialize?

  • NEDav

    I really enjoyed this article. As a healthy 40ish women, I think that primary care drs. are taking themselves out of the market. Each and every time I have been ill in the last few years, I call my primary and they can see me next year…So I visit an urgent care or walgreens like facility. With the hours that most offices keep, I can’t make an appt as I work full time, with little time off. I have no choice. If primary care offices were smart, they would change their bankers hours and open a urgent care in conjunction with their primary practice.

  • http://www.facebook.com/people/Greg-Mercer/100001786695804 Greg Mercer

    Medicine has generally prioritized on Primary Care only to the extent its members have shifted away from it to easier and more luctrative options. Unless you plan to fill a role and have a viable way to do so, it is the lowest form of meanness to attack others who fill the gap you create.

    • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

      Greg,
      This article is not an attack on those that are trying to fill a gap that has been created. Dr. Kevin is saying that if more had been done to encourage others to go in to Primary Care then this type of situation might not occur. Now, as far as these ones that are trying to fill in the gap created having the NPs and the PAs is still not going to be enough to fill the gap. More doctors are still needed. You can have all the NPs and PAs you want to try and fill in the gaps and it still won’t be enough. Also, having more doctors is necessary because there are going to be people that refuse to see NPs for care and would rather see a doctor. The person should have the right to see whoever they want as their primary care provider. Some people (myself included) are not comfortable with the idea of a Nurse trying to be something they aren’t: a doctor.

  • John Henry

    They will have plenty of company very soon. Nearly all the big EHR vendors are shifting to a cloud hosting model which will result in large and data-mine-able silos of medical information, particularly once ICD 10 descriptors are implemented, all of which will give detailed contemporaneous accounts of patients and their diagnoses over time, information from which large enough cohorts of patients can be drawn to see what interventions are effective in reducing new or elevated complexity of disease. The purposes will be myriad. The government will want that information to assemble reliable data-driven profiles of what care is necessary and what is superfluous for patients based on disease, age and whatever other definers can be queried. From that will come new care guidelines defended by statistically-significant data, and more importantly, payment limitations. This, through the easily controlled “ACO” management models will allow the same level of costs controls on outpatient care as presently exists by DRGs for inpatient care. Companies, market analysts and all sorts of statisticians will want and use that data. “Accused of selling data” is laughable for its naivete; every company with a silo full of data will be offering to sell information in every way imaginable. As long as privacy is not breached, it will be OK.

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