There were several letters in the July 9th edition of the Chicago Tribune about this topic, apparently in response to a Trib editorial about clinics that are run in retail stores to provide primary care to patients. Two were from physicians, and one was from an angry patient.

The background is that the medical societies oppose these types of clinics, which possibly could save patients money and time and give them increased access to health care. That all sounds good, doesn't it? Sounds like a reasonable solution to some serious issues with health care today.

The first letter, from an MD, suggests that these types of clinics are another nail in the coffin of the primary care practice. He states that "in the short run, patients might have some easier access, but in the long run there will be fewer physicians entering primary care." This is because these clinics will "cherry pick" the easiest and simplest complaints or illnesses that patients might now go to a primary care office, leaving only the more complicated cases. With reimbursements for primary care held down by insurance companies and government regulation, the profitability of such practices will get even worse than it already is now. "If you remove the simpler and quicker visits," says the letter writer, "most primary-care practices will lose significant income."

And it is not true that these offices are mega-profit centers. Perhaps the doctors who own and staff them are better paid than the average American, but shouldn't they be? I don't think that a lot of these physicians feel it is worth the workload and the risk associated with such a practice.

The second article is by the president of the Illinois State Medical Society, and he tates that ISMS is not necessarily trying to put retail medical clinics out of business, but is trying to improve the clinics' operating model so that patients are protected, as are others in the retail establishment where the clinic might be located. This doctor states that most of the clinics don't have to meet basic sanitary standards such as a separate waiting room, a dedicated bathroom facility, and running water in exam rooms. Plus there is conflict of interest when a retail establishment might be selling products such as cigarettes which cause ailments that might be treated in such a clinic.

Then there is the letter from the angry patient whose letter is titled "Doctors aren't gods". She had a bad experience with a wait at a primary-care office when her child needed a kindergarten physical. She was on time for her appointment and had to wait 3 hours before the doctor saw her daughter. It also seems the doctor wasn't very sympathetic to her wait. She concludes her letter with these words: "These doctors should wake up and realize they are not gods. A little consideration for the patients goes a long way." I don't really want to defend an office that makes a patient wait even 1 hour for an appointment, without apologies and explanations and giving the patient the opportunity to reschedule. I know that pediatric offices often have 4 or more patients scheduled for each 15 minute interval, which in my view is just nuts.

In all fields of medicine (and dentistry) unexpected things come up at times that put one behind. I don't know what besides simple overbooking could account for a 3 hour delay, but I'd have been gone after about an hour or maybe 1 1/2 hours myself. But I have yet to meet a doctor who thinks he or she is a "god". Arrogant, yes. Cocky, confident, to be sure. Poor people skills? Yes, at times. Not as compassionate as they maybe should or could be? Also yes, at times. The doctor may not have been as concerned about the lateness as she should have been, but this letter writer doesn't know what has already happened in this office's day. Maybe a little kid presented with a serious medical problem, and it took an hour to deal with the parents. I don't know. No one does, not even the letter writer.

The point of all this is simply that, as I've blogged before, any attempts to address the serious health care issues that face this country better pay as much attention to the PEOPLE providing care as they do to the dollars and cents of an issue. After all, you can't FORCE someone to become a physician if the field is all stress and risk, and no rewards...