Blog by Sumana Harihareswara, Changeset founder

16 Jan 2007, 8:21 a.m.

Bad Relationship

Hi, reader. I wrote this in 2007 and it's now more than five years old. So it may be very out of date; the world, and I, have changed a lot since I wrote it! I'm keeping this up for historical archive purposes, but the me of today may 100% disagree with what I said then. I rarely edit posts after publishing them, but if I do, I usually leave a note in italics to mark the edit and the reason. If this post is particularly offensive or breaches someone's privacy, please contact me.

Established doctors' offices face new competition from quick clinics at drugstores & big-box stores that dispense flu shots, etc. Unlike the RIAA, physicians don't try to legislate new competition out of existence, but argue on the merits and try to adapt.

I have never been to a quick-care clinic, retail clinic, convenient care clinic, what have you, but I am already a huge fan of the concept. Any innovation in health care that makes it more convenient to do the quick and easy stuff is one I can applaud.

Rockville parent Meredith Salamon is inclined to agree. Dropping into a MinuteClinic in a nearby CVS pharmacy last month to get flu shots for four of her five children, she says she was in and out in 15 minutes. "The cost was good, and the location was good, so it was easy and quick," she said. By contrast, she says, the family's more expensive traditional doctor "kept running out" of flu vaccine and keeps inconvenient hours.


"Many patients would like to get in to see their primary care physician, but when they call, there is no appointment available," [Anne Pohnert, MinuteClinic's manager of operations for the Washington area] says. Choosing an urgent care center or emergency facility may involve "a long wait and considerably more cost," she adds. "We believe that a visit to MinuteClinic instead of an ER on a Friday evening for a five-minute strep test is a win-win for patients and insurers trying to save time and health-care costs."

Traditional practitioners complain/worry that the new clinics have poor follow-up with patients' primary care physicians, and that long-term stuff won't get done:

"Parents may say, 'It's just a sore throat,' " explains Corwin, a practicing pediatrician in Rochester, N.Y. But those sore throat visits, he says, are a pediatrician's "vehicle to continue developing the relationship with the family."

Van Vleck agrees: "When I see a kid for a sore throat, I get to go through their chart. If they have a little bit of scoliosis I might check their spine. I will check their immunization record. We go over the record, and we try to go over what's going on besides the sore throat, or besides the ear infection."

So it sounds like the worry is, if people keep going to the 15-minute convenient clinics and never spend the time to go to their doctors for physicals, they won't get long-term preventive care, or form the long-term trust bonds with their doctors that doctors need. But I get something like 15 minutes of my doctor's time twice a year anyway, with maybe a minute (if I specifically ask!) on preventive care. And what with insurance changes and moving, it's been a different doctor every year. You want a relationship with me? How about answering the phone if I call, day or night? How about seeing me when I need it, day or night, within a day? How about locating yourself near public transit so it doesn't take half a day to get to your office and back? And if the traditional medical establishment wants this "relationship" too, how about single-payer healthcare so I can keep my doctor if I change my job, and so I can see you regularly, instead of making the health/copay tradeoff?

We used to make jokes about the horrible usability at the Department of Motor Vehicles. US health care has the worst usability of any major industry or agency. If you think government agencies are bureaucratic and inefficient, look at health care insurers, who make money every time they can force you to pay for something you thought they covered in their labyrinthine policy. There's an answer. Gladwellian goodness here.