A Pretty Hollow Complaint, Doctor


The AMA and their current president can lament until the cows come
home, but they haven’t done a damned thing to provide medical care to
the poor before it becomes a matter of emergency rooms. By then, the
acute has become chronic. I doubt that anyone even vaguely connected
with the self-righteous AMA has ever sat up with a seriously sick child
and had no place to go.

Minuteclinic
Ranit Mishori, (himself a family-medicine resident at Georgetown
University/Providence Hospital) writes in the Washington Post about an
intriguing, new, and (in the eyes of some physicians) controversial
medical treatment philosophy;

Some of the newest players in health care are rubbing doctors the wrong way.

You
may know them: those small clinics at your neighborhood Wal-Mart,
Target or CVS that promise quick attention for routine visits — sore
throats, minor aches and pains, flu shots — with no appointments
needed. The clinics, which go by such names as MinuteClinic,
RediClinic, QuickClinic, Medpoint Express, Curaquick and MediMin, offer
convenience and low price — scarce commodities in today’s medical
marketplace. But while consumers are taking to the concept, physician
resistance is building.

I’m not an unbiased
observer in this controversy, because I have long advocated just such
centers, across the nation and operated on the McDonald’s model of low
cost and universal sameness. It fascinates me that private capital has
wedged itself into a market where public access has increasingly failed.

  • Emergency rooms have become the source of primary medicine for the poor.
  • Children, particularly inner-city and poor children, are not sufficiently served by public medicine.
  • The cost of this ignorance toward the poor and the uninsured is
    short-term individual health crises that turn into long-term
    disabilities.

The market speaks for itself—these facilities are a public success.
But the familiar whine of the AMA and various doctors can be heard in
the background like chainsaws in the north woods. From Mishori’s
article;

"The quickest, most convenient medical care is not always the best," says
Caroline Van Vleck, a Washington pediatrician. Particularly, she and a
growing chorus of primary care physicians contend, when it comes to
children.

Emergencyroom
Van Vleck is hard to argue against, as far as she goes. Problem is, the
best is not even an option to huge portions of the population. Their
option is none at all,
until the relatively simple case of a sore throat or chronic cough gets
to the point where a frantic mom takes her child to an emergency room
in the middle of the night. Guess how much chance that poor and
uninsured mom has of getting her child admitted. Yeah, that’s right. None.

There is the world as we would have it—the well scrubbed and best-care world of Dr. Van Vleck–and then there is the real world.
In that grubby, dangerous, unsanitary real world of the poor and
uninsured, MinuteClinic, RediClinic, QuickClinic, Medpoint Express,
Curaquick (or any such available option) is a life-saver. These clinics
exist because private physicians and public medicine have failed those
who need it most.

"Convenience is not enough," the
AMA lamented in a recent editorial. Comparing the mini-clinic
phenomenon to kudzu — the tree-strangling vine rampant in the South —
the AMA complained these new services are spreading too far, too fast.
In a policy statement issued this fall, the AAP "opposes retail-based
clinics as an appropriate source of medical care for infants, children,
and adolescents and strongly discourages their use."

Plestedamapresident
The AMA and their current president can lament until the cows come
home, but they haven’t done a damned thing to provide medical care to
the poor before it becomes a matter of emergency rooms. By then, the
acute has become chronic. I doubt that anyone even vaguely connected
with the self-righteous AMA has ever sat up with a seriously sick child
and had no place to go. Kudzu is a plant of opportunity and so is the
failure of national health. Each of them thrive where no one cares.

Interestingly, on the AMA web site Advocacy Page, their first three goals are listed in this order:

  • Medical liability reform: To preserve patients’
    access to care, the AMA will continue to lead an aggressive, multi-year
    campaign to reduce medical liability premiums.
  • Medicare physician payment reform and regulatory relief: As
    the leading force in Washington for Medicare reform, the AMA will be
    relentless in the battle to replace the flawed Medicare physician
    payment formula.
  • Expanding coverage for the uninsured and increasing access to care: The
    AMA is committed to leading the response of America’s physicians to
    solve the health coverage crisis for all uninsured patients.

So, after all those predominantly white and predominantly rich and
predominantly insured members of the AMA get their liability eased and
their payment schedules improved, then they might get around to expanding coverage for the uninsured. Meanwhile, they’ll continue to oppose and strongly discourage.

The poor and uninsured certainly ought to rally around that flag.

Drrobertcorwin
In more blather from the American Academy of Pediatrics,
Robert Corwin, who recently served as a director, worries about a
child’s receiving medical care at different places by different
providers — most retail clinics are staffed by nurse practitioners and
physician assistants, not doctors — who may not communicate with one
another.

Children, he argues, need a "medical home"
— a place offering comprehensive, family-centered, coordinated,
continuous care, in which a doctor knows the patient over time.

"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."

Childpatient
Planet Earth, calling Dr. Bob—these clinics are a life-saver to
children who hardly have any home at all, much less a ‘medical home.’
The current vehicle that fails medicine is most often a Mercedes or
Jaguar and before developing relationships with poor kids’ families, a
whole lot of self-serving and profitable layering of interventions to
the practice and delivery of medicine are going to have to be torn
apart.

In the meantime, the market will have to serve where doctors fear to go.
___________________________________________
Media comment:

2 thoughts on “A Pretty Hollow Complaint, Doctor

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