Speed vs. quality: Retail-based clinics

ByRichard Lander, MD

Some of your patients’ parents may ask whether they should bring their children to the pediatrician when they are sick. They may say that it is so much easier to run over to the local retail-based clinic at the pharmacy, where there is lots of parking, they don’t need an appointment and they can pick up tissues, milk and medicine.

Remind those parents that first of all, most retail-based clinics (RBCs) are not staffed with board-certified pediatricians. Their child will probably be diagnosed and treated by a nurse practitioner or medical assistant. Second, imagine if the parent is concerned about their child and, therefore, a little distracted, and the child ends up having an allergy to an antibiotic. This could have a bad outcome. If you are at the pediatrician’s office, that information is kept in your child’s chart.

Richard Lander

Now, imagine that the child’s condition worsens at midnight. The RBC that the patient visited earlier is now closed and no one is available for further advice. On the other hand, had the parent called the pediatrician earlier and then required additional help later in the evening, the parent would be able to receive consistent medical advice because there is always a covering doctor on-call 24/7. The AAP has always stressed the importance of continuity of care. It’s what I want for my children, and it’s what I want for my patients.

Limitations

Many RBCs have an age below which they will not treat a patient. What will the parent do if two of their children are sick; take one to their doctor and the other to the RBC? Worse still, the RBC cannot deal with complex medical issues. So if the parent and child visit the RBC with a problem that is beyond the scope of their training and knowledge, they will send them to their doctor or the emergency department.

Let’s think about vaccines. If the child needs influenza vaccine, as well as one or two other immunizations, many of the RBCs are only prepared to give influenza vaccine. If the child is receiving influenza vaccine at the RBC and all other immunizations at the pediatrician’s office, no one will have the child’s complete vaccination record. Once again, this speaks to a lack of continuity of care. This fragmented record-keeping could cause trouble in the future.

The pediatrician’s office should be the child’s medical home. Pediatricians care for children’s physical and mental well-being since birth. Pediatricians provide vision and hearing screening, and each child’s fine and gross motor skills. They check for autism and attention-deficit/hyperactivity disorder, ask questions to parents that relate to their children’s growth and development and are also able to address concerns if they arise.

If a behavioral problem occurs at school or home, it is the pediatrician who will think about the possible medical conditions that could be causing these behavioral changes. Parents must think about whether an RBC will help a child who is crying out for attention secondary to a new baby at home or to parental discord; and about whether someone from the RBC would talk with a teenager about depression, alcohol, drugs or tobacco use. If a child has a gastrointestinal problem, a broken arm, a heart condition or a blood disorder, will the RBC recognize the problem and send the patient to an appropriate specialist? As a parent, would you want the recommendation of a competent specialist to come from an RBC or from your doctor who knows you and your family’s medical history?

Continuing education

Pediatricians provide children with vaccines after they have looked at the medical research. They do not give vaccines because a corporate entity (RBC) made the decision to do so.

Pediatricians attend medical school and complete a pediatric residency for an additional 3 years and continue to educate themselves by attending medical conferences and read the medical literature to ensure they remain current and ahead of the curve.

One of the national RBC chains has a tag line that reads, “You’re sick. We’re quick.” Is that the kind of medicine your patients deserve?

Richard Lander, MD, is a pediatrician in private practice in northern New Jersey and is a member of the Infectious Diseases in Children Editorial Board.

Disclosure: Dr. Lander is co-owner of both the National Discount Vaccine Alliance, and Resources in Physician Management Services. He is also a speaker for Merck, Sanofi-Pasteur, Novartis and Pfizer.