Unless someone is completely media averse, Walgreen’s decision to treat chronic diseases in their Take Care Clinics should not come as news. Patients rarely ask me how I feel about going to Immediate Care Centers or the “Quickie Mart” versions in retail pharmacies and grocery stores. Unfortunately as primary care physicians became harder to see at convenient hours, people went to physician-staffed Urgent Care Centers on the weekends and evenings originally. Then retail centers staffed by physician assistants and nurse practitioners opened for simple acute problems. Now Walgreens plans to care for patients’ chronic conditions, like hypertension, diabetes and asthma. They announced this as a way to “bridge the gap in patient care” and “improve care coordination”. Given that I have never received records on a patient treated in one of their Take Care Clinic, it makes me a bit skeptical of the latter.
Do I think this is optimal care? No. I’ve worked with many excellent nurse practitioners, one, in fact, who was better than many doctors. But she knew her limits and I worry that the staffing at these clinics will not have individuals of her caliber and experience in them. Will this worsen the fragmentation of medicine, a fragmentation that is exacerbating medical errors in an outrageous way? Yes. But I recognize that money and demand will out-trump best care most of the time. And I agree with Dr. Pho’s assessment that we brought this on ourselves(1).
My hope is that my patients will continue to seek care from me first. In turn I will try to develop other options to make myself more available. Presently I encourage patients to use my patient portal and soon, I hope to convince my employer to consider telemedicine capability.
It’s the future. I’d like to start the trip there now.