Fast Food Medicine

"Would you like fries with that?” 

"Would you like to upgrade to a large soda instead of a medium?"

“Would you also like an additional blood test for Lyme disease?”

Sure why not? I love fries!

And a larger drink? Heck yeah, if it's only a few cents more.

I'll also take that Lyme disease test, just to be on the safe side!

The above sounds like a great fulfilling experience.

You get delicious inexpensive food, served by very pleasant and efficient people that were also willing to cater to whatever you want. You also get a doctor who seems to really care and thorough by ordering a battery of tests. It's the kind of experience and place that anyone would want to keep coming back to, again and again.

This is not the typical experience many patients (consumers?!?) have when they interface with our general healthcare system. Healthcare is not inexpensive, not convenient at all and the quality of the product is variable. And in many cases the experience is very unpleasant.

"Necessity is the mother of all invention."

What started out as filling a void for overcrowded emergency rooms and unavailable primary care physicians, urgent centers have been flourishing. It's simple supply and demand. Supply of primary care doctors are dwindling and the demand for more convenient patient care is increasing. Now in any of your neighborhoods, you can get coffee, fast food and some "healthcare" rather quickly and merrily. 

I've gotten used to counseling my patients on the dangers of obesity and its association to fast food. Lately, I've had to start counseling my patients on the dangers of fast food medicine. Although I recognize their need and why they appeal to patients (consumers!?!), I have serious concerns about the impact Urgent Care centers have on healthcare at large. Just in the past few years, these are the types of issues I've noticed from care provided by such places.

Over prescription of antibiotics

Unnecessary use of broad antibiotics

Shot gun blood work with spurious findings

Recommendations to pursue unnecessary advanced imaging

Unnecessary recommendations to see specialists

Patient expectations for over treatment and extensive work ups

These are just broad generalizations but after a years, my patient sample size is growing.

I'm not a business man, but in the "for-profit" world" you do things that get you paid (x-rays, blood work?) and you give the consumer what they want to ensure return business. These are dangerous business concepts when applied to healthcare and urgent care centers are rapidly becoming the prime example of this. 

As the cost of our healthcare approaches 20% of our GDP and medical educators at all levels preach value and cost, urgent care centers, retail clinics and their profit incentives threaten to undermine this entire movement.

I'm not the only one that is worried about this.

The link below comes from a blog post on Kevinmd.com echoing similar sentiments. 

KevinMd.com Blog Post on a resident's experience in an Urgent Care Center