Wednesday, September 17, 2014

I really admire Shannon Brownlee, but I have to take issue with the parts of her Providence Journal article in which she takes CVS to task for running Minute Clinics in their stores.  But perhaps we end up in the same place anyway!

In summary she argues:

For-profit retail clinics are a bad sign to anyone who understands the special role of primary care in providing good health care to a very sick nation.

Primary care is one of the few places remaining in the medical system where physicians and patients have direct personal relationships that last longer than any particular treatment or illness.  

But CVS and other companies diving into primary care aren’t interested in building relationships. Patients are customers, not vulnerable human beings, and the health professionals who work for them are employees, not caregivers. For these companies, health care isn’t about caring or healing — it’s a product — and their interest in providing it is aimed at the bottom line. In the future, your relationship with your doctor will be about as meaningful as your relationship with the local barista at Starbucks.

By siphoning the easy cases and easy revenue away from primary care offices, retail care further undermines their financial stability.

But then she points out the problems in maintaining traditional primary care practices:

You can’t blame retailers for jumping into the business of offering primary care services. The fact is, primary care doctors have failed to provide services that patients need: fast care for minor ailments, and care that’s available in the evenings and on weekends.

For the sake of all those who have a chronic illness now, or who are destined to get one as they grow old and frail, the nation had better figure out a way to support primary care practices. 

I don't think we should blame the retailers for filling a gap in the healthcare system nor should we demonize them or their clinical staff by saying they really don't care about people's health. Where Shannon and I appear to agree, though, is on a key point:  If the country really wants to support primary care, there are ways to do that, starting with fixing a perverse reimbursement system.


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