More on in-store health clinics.

From the New England Journal of Medicine. 

I didn’t know that the "Minute Clinics" we were discussing in an earlier post about them being banned in Boston had debuted here in Minnesota. 

The article says that the menu of services offered at "typical" in-store clinics is "strikingly small," but if you look at the "sample menu" you will notice that they diagnose or treat conditions that are also strikingly common.   Apparently, my family of five could have replaced every doctor’s visit we’ve had this year, except my routine gynecology exam, with a visit to a "typical" in-store clinic.  Bladder infections, ear infections, strep throat, vaccinations, cholesterol screening, it’s all there.

Here is a quotation that sums up well why the model appeals to me:

Second, in-store clinics place patients in a new role, as they become responsible for sorting their medical problems according to their complexity. Because some menu items are diagnoses, there is an implicit assumption that patients can make their own clinical judgments, relying on clinics only to confirm the diagnosis and deliver the treatment. The clinics’ highly engineered business and operational models are very sensitive to misclassification. Attracting patients for whom the clinic is not configured — for instance, someone with an acute, life-threatening disease — would cause a serious delay for others in the queue and weaken the customer value proposition of speed and convenience. Clinics, however, say that such occurrences are less common than one might fear; Michael Howe, the chief executive officer of MinuteClinic, notes that less than 10% of patients are turned away at his company’s clinics, which have never had a patient present with chest pain, for instance. With regard to the circumscribed set of conditions on the menu, patients have turned out to be capable diagnosticians. Moreover, some patients — and not just those in higher socioeconomic groups — seem to be happy with this role and comfortable arranging their own care.

I think it’s about time we shift the perception of responsibility and capability for medical decisionmaking back just a little bit onto the patient.   That physicians have to make risk-based decisions under the constant threat of unreasonable malpractice lawsuits is good for nobody.