A friend of mine recently had a very sore throat. She knew how to manage her symptoms — lozenges, warm tea and the like. But she was worried she might have strep and would, therefore, need antibiotics. That should be a simple question to answer with a quick trip to the primary care clinic. Except that her primary care physician was booked, and if she wanted an unscheduled appointment with someone else in the clinic, she was told that she would probably wait a couple of hours.
So she went to a “doc-in-the-box,” which according to the Urban Dictionary is “any doctor at a walk-in clinic.” She paid a modest fee and in a short time received a throat swab. The swab didn’t detect any strep, so she was soon back at home, with a tea kettle brewing and no fear of serious illness.
Primary care clinicians have a new competitor. Minute clinics, retail health clinics and other convenient alternatives are rapidly popping up in many parts of the country, meeting an unmet demand for timely, affordable care for minor complaints. The biggest players in this field include companies like CVS. These minute-like clinics are a real growth industry.
However, some physicians are critical of these clinics, for skimming off uncomplicated care, for not having longstanding relationships with their patients and for not being skilled enough to recognize when people need more advanced care.
But the American College of Physicians (ACP) disagrees. The ACP is one of the most respected professional organizations in the country, famous for the rigor of how it weighs medical evidence. The ACP recognizes physicians’ concerns about retail health clinics but believes that these clinics deserve a place in the U.S. health care system. Here’s a quick summary of their position, which should give you a guide in deciding when and whether to receive care at such clinics:
1. For selected, “low-acuity conditions,” the quality of care at retail clinics is similar to traditional doctors’ offices. Poison ivy? Sore throat? It’s probably OK to go to a retail health clinic. Chest pain? Fainting spells? Definitely, not such a good idea.
2. Retail health clinics are an acceptable alternative “for relatively healthy patients without a complex medical history.” So if you suffer from diabetes, coronary artery disease and a touch of emphysema, you should go to your own doctor rather than a retail clinic that doesn’t know your medical history and that may not be equipped to evaluate how your current symptoms relate to your other problems.
3. You should make sure the clinic clearly discloses its “scope of clinical services.” The clinics need to know what they can and cannot do. If they aren’t clear about this scope of services, it’s probably best to go elsewhere.
4. If you do go to a retail health clinic, make sure to let your primary care physician know.
5. Don’t accept referrals to sub-specialists from retail clinics. If the clinicians there think you need more advanced care, you should contact your primary care physician first.
6. Don’t use retail clinics for long-term management of chronic diseases. If you need your blood sugar lowered or your blood pressure controlled, get in to see a primary care clinician who can follow you over time.
Until and unless traditional primary care clinics start providing more timely care to their patients, doc-in-the-boxes will continue to proliferate. Consumers should keep these six tips in mind, so they make better use of such clinics.
Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel. He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. This article originally appeared in Forbes.
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