Who's minding the store? Health clinic beyond aisle nine

In one trip to the local Wal-Mart or Target, depending on where you live, you can pick up a gallon of milk, a car battery -- and a strep test. That's because the nation's two largest general merchandise retailers, along with some grocery chains and other retail outlets, are renting space to store-based clinics.

The name of the game is convenience. Instead of waiting for a doctor the next day to check your sniffles, or taking off work to squeeze in a sick visit because of your sore throat, why not just stop by and have a nurse practitioner check you out? For the retailers, the object is to offer another service to their customers, and perhaps have them spend a little money in the store while they wait, and take their prescriptions to their in-store drug counter.

Certainly, there's nothing wrong with making health care more convenient and available to patients. But a quick visit to a store-based clinic is no substitute for regular care from a physician. Health care isn't just about convenience; it's about quality as well.

Here's the way many store-based clinics work: A nurse practitioner or physician assistant is aided by diagnosis software in determining what might be the reason for a patient's particular symptom. Generally, if the diagnosis is going beyond a minor, easily treatable condition, the NP or PA is supposed to consult with a physician assigned to, but not present in, the clinic, and if necessary recommend that the patient seek further care elsewhere.

With store-based clinics fairly rare at this point -- Wal-Mart, for example, only has three now open, and the number of store-based clinics overall likely isn't much into the triple digits -- organized medicine has not weighed in with formal policy regarding such clinics. But the AMA and several state medical societies are expressing concern that these clinics not usurp physician-patient interaction, that there be appropriate physician oversight of the store-clinics, and that patients recognize that not all minor symptoms might be so minor.

"Human health is complex," AMA President J. Edward Hill, MD, wrote in a letter published in the Sept. 15 issue of the Tennessean newspaper in Nashville, on news that Minneapolis-based MinuteClinic was opening facilities in six CVS pharmacies there. "What may appear to be trivial or obvious can originate in a totally different body system and can have profound health implications. For example, a person with what at first appears to be a strained shoulder muscle due to a weekend football game might actually be suffering from a heart attack. Optimal patient care is best achieved when each member of the health care team works with others to deliver care appropriate to their expertise and training. Physicians have always been and must remain an integral member of that team."

As store-clinics proliferate, patients need to know that they shouldn't neglect the essential role of the physician -- both in terms of preventive care and when illness strikes -- in favor of being treated symptom by symptom in a store-based clinic.