[NPInfo] Interview that was a bit slanted

[David Mittman]

Always nice when an official from the National Institute of Health  
really has little idea what NPs (or I bet) PAs do.
Read below:
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Wise To Use Pharmacy Walk-In Clinics?
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They’re convenient, comparatively inexpensive — and they’re number is  
growing in a hurry.
According to the Deloitte Center for Health Solutions, there were just  
250 such clinics nationwide in 2006. By the end of last year, there  
were more than 800. And it’s projected that there will be more than  
5,000 by the end of the decade.
But are they what the doctor ordered?
Dr. Ezekiel Emanuel, chairman of the Bioethics Department at the  
National Institutes of Health, examined them on The Early Show Saturday.
We used to schedule appointments with the doctor for everything from  
immunizations to serious illnesses. But the reality today is that a  
doctor’s office visit can be expensive and difficult to book. With so  
many people without health insurance, and time at a premium, the  
pharmacy chains are offering the clinics as a way to fill the gap.
The clinics are usually staffed by nurse-practitioners, though more  
and more are being staffed by doctors.
No appointments are necessary, and most have late hours.
In a survey by Deloitte, 34 percent of consumers say they’d use a walk- 
in clinic, and 16 percent say they already have.
What’s more, many insurance companies are now covering visits to those  
clinics, with much lower co-pays than they charge for visits to a  
doctor’s office. And with a growing number of Americans living without  
health insurance, prices, which range from about $59 to roughly $95  
for visits and preliminary exams, the clinics may be becoming a viable  
alternative for people in need of quick, simple treatments.
Dr. Emanuel’s take on them, as told to CBS News:
WHY ARE SO MANY PEOPLE USING CLINICS RATHER THAN VISIT THEIR OWN  
DOCTORS?
Because they’re convenient, simple and fast, bottom line.
IS IT SAFE TO USE A CLINIC THAT MIGHT BE MANNED BY A NURSE  
PRACTITIONER RATHER THAN A DOCTOR?
That depends in large part on what you’re going for. It will certainly  
be less expensive and more efficient. But they break down when it  
comes to chronic disease or following up an illness. They are very  
good for acute things, but not for long-term care. The role of the  
nurse practitioner is decided by the state, but in some states, they  
can do nearly everything a doctor can in that situation, including  
writing prescriptions.
Use the clinics only for acute problems, such as ear infections, sore  
throats that may be strep throats, or vaccinations. But if you have a  
serious and/or chronic problem, such as diabetes, asthma, etc., see  
your own doctor, or go to the emergency room.
“This is about short, simple stuff,” Emanuel said on The Early Show  
Saturday. “It’s not about complicated health problems,” and if you  
suspect or are told at the clinic that it is a more complex problem,  
“Go into the mainstream system” by heading for your doctor or a  
hospital. “This is certainly not a replacement for the doctor,” he  
stressed.
In general, he added, “It’s a little too early to tell how safe they  
(the walk-in clinics) are. But there is a big incentive for them to  
work on the safe side and follow very strict protocols for most things.”
HOW CAN YOU MAKE SURE YOU’RE GETTING THE RIGHT CARE WHEN YOU GO TO A  
WALK-IN CLINIC?
This convenient care can be integral, but it can’t be stand-alone or  
it won’t be helpful. It’s convenient for what you don’t need high-tech  
for. As long as someone is watching the whole continuum of care, you  
should be OK. If you have a regular doctor and you’re going to use a  
clinic, let your doctor know, get a printout at the clinic, and show  
your doctor what you’ve had done — so your doctor is kept up-to-speed  
on all your care: “There is a concern that (clinics) will increase the  
fragmentation (of care) — that you’ll get a little bit here, a little  
bit there, and no one will have a whole picture of your health, and  
something could fall through the cracks,” Emanuel pointed out on the  
show.
MANY CLINICS ARE AFFILIATED WITH HOSPITALS NOW. IS THAT SOMETHING TO  
CONSIDER IF YOU’RE THINKING OF GOING TO A RETAIL CLINIC?
The challenge is how to integrate this into our current medical  
system. Affiliation with a hospital is important, because there has to  
be a continuum of care. It’s also important so there aren’t double  
treatments — if your child has his vaccine, he won’t get it again if  
he goes to a doctor or hospital. If the clinics are affiliated with a  
hospital, that hospital may want to staff them with their people.
WHAT DOES THE HOSPITAL GET?
Hospitals are always looking for referrals. They look crowded because  
emergency rooms are crowded. People use emergency rooms for primary  
care, which is not how they are designed. But hospitals are trying to  
market themselves, to get patients to use their facilities, and this  
is a good way to get patients to use a particular hospital, by  
referral from the clinics.
ARE CLINICS OPENING THEMSELVES UP FOR POTENTIAL LAWSUITS?
Yes, certainly, it only will take one mistake, one misdiagnosis, to  
start a pile of lawsuits. But the clinics shouldn’t get in over their  
heads; they should know when to send customers to a real doctor.
HOW DO DOCTORS FEEL ABOUT THE GROWTH OF THESE CLINICS?
Some still can see this as competition, can be hostile; it takes  
patients away. But it should be a wake-up call for doctors: We need to  
see care through the eyes of their patients, rather than our own, and  
make that care more accessible.
Source: CBS News
Original Publication Date: August 2, 2008
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