House Calls / Dr. Michael Schwartz

Recently, a major national drug store chain announced a plan to expand its scope of services from selling prescriptions, over the counter drugs and other retail items, to now providing actual patient health care, including diagnosing and treating of patients with acute and chronic medical conditions. Specifically, the plan includes the medical management of patients with hypertension, diabetes, high cholesterol, asthma and several other diseases. Many drug store chains already offer immunizations for patients (such as flu and pneumonia shots) and some also offer "sick visit care" for colds, rashes and minor injuries. However, this is the first time a company has announced full-service medical care.

While these chronic medical conditions are generally treated by primary care doctors such as internists and family practice physicians, these drug store clinics will be staffed with nurse practitioners and physician assistants. Physician groups around the country are concerned about the fragmented care this will cause for their patients as well as the provision of health care with minimal physician oversight.

The company's contention is that providing these services will offer customers more flexible hours and more affordable health care, yet many in the medical industry are concerned that this plan is merely being added as an additional revenue stream for the company. Obviously, many physicians see the entry of drug store chains into the primary care business as direct competition, however, more importantly, physicians are concerned that the doctor/patient relationship would be jeopardized by these services and quality of care will be compromised.

Moreover, there are many other serious issues to consider when a patient seeks care at one of these clinics. Whereas a primary care physician typically has a recorded detailed medical history for each patient, the practitioners at these clinics do not have access to this vital information. For example, many patients may not recall previous interactions or adverse reactions they may have had from commonly used medications. They might also have medical conditions which preclude the use of certain drugs or contra indications to certain tests that are in their primary care's records but not recalled by the patient. Additionally, some abnormal blood tests may have already been evaluated in the past and reordering these tests, or treating them, would actually add additional costs to our already overburdened medical system. Finally, some patients have a poor understanding of their medical history and may not be able to properly explain previous diagnosis and treatments.

Another concern is the experience of the health care provider employed by these drug store chains. How long have they been working in primary care? Will you see the same caregiver each time you go into the store or will you have to explain your medical history over and over again each time you seek care? Additionally, while nurse practitioners and physician assistants are qualified for certain health care diagnosis and treatment, and are duly recognized as an essential part of the health care system, the educational and practical experience of a physician compared to an ancillary care giver is quite significant. A physician's education and training far exceeds that of the nurse practitioner or physician assistant. Many cases require a higher level of education and understanding in order to identify and treat many acute and chronic conditions.

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Finally, there is a perceived conflict of interest if a patient is prescribed a medication at these clinics and then asked to take the prescription to the store counter to be filled. While patients certainly have a choice as to where to fill the prescription or purchase the over-the-counter medication, convenience will dictate that the purchase is made in the same retail store where they are being seen for their medical care.

Everyone agrees that medical care is changing. The implementation of Obamacare will be a strain on the already limited number of primary care physicians across the United States. Ancillary practitioners will continue to play a critical role in health maintenance and enable patients to have better access to health care. However, the introduction of drug store clinic centers without physician supervision will very likely result in adverse outcomes and inadequate health care. Physician groups recommend caution if you choose to utilize these services. The Hippocratic Oath states, "never do harm," thus it is the physician's responsibility to make certain that patients are given the best health care possible. Let's not short change ourselves by going to a "five and dime" for our health care.

Dr. Michael Schwartz is board certified in internal medicine with a private practice in Darien. For comments or questions, please visit