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Coming soon to a department store near you: medical care

Los Angeles Times

Coming soon to a department store near you: medical care.

Adding a new spin to shopping centers' all-in-one idea, department stores, grocery chains and other retailers are adding medical clinics that promise to diagnose and treat common ailments such as ear infections and sore throats in as little as 15 minutes. No appointment necessary.

Staffed solely by nurse practitioners and physician assistants and with slogans such as "You're sick, we're quick," the clinics are aimed at people frustrated by long waits at the doctor's office or emergency room, as well as parents who suspect their child has strep throat but want a quick confirmation and a prescription. Many have menus of medical services that resemble signs at a fast-food restaurant. And some hand out beepers so you can shop while you wait.

While prices vary, and some clinics don't take insurance, the costs are relatively cheap. For instance, a test for strep throat in a retail clinic runs around $40, about half of what it would cost in a typical doctor's office.

"This is for people who are in a hurry," said Linda Hall Whitman, chief executive of MinuteClinic, a Minnesota-based company founded by a doctor and two business partners. MinuteClinic, which claims to have treated more than 150,000 patients in 14 clinics nationwide, last month opened eight quick-care centers in Target stores in the Baltimore area. The company plans to add 200 locations in two dozen cities in the next four years.

Several other companies, with names such as FastCare and MedSpot, have recently opened centers in supermarkets and drugstores in cities such as Louisville, Ky., and Fort Wayne, Ind.

Though the clinics are convenient, some doctors worry about the cash-and-carry approach to medical care. Dr. Rebecca Patchin, a Riverside, Calif., anesthesiologist and trustee with the American Medical Association, said nurse practitioners can be excellent at treating common illnesses such as sore throats and seasonal allergies. But she worries about patients who come in with minor symptoms that can mask much larger problems. "What about the guy who has a sore throat because his undetected diabetes is leading to infections or the indigestion that's a sign of possible heart attack?" she asked.

Patchin, a former nurse who got her medical degree more than a decade ago, insists this isn't simply a turf battle between doctors and nurses. The reality, she said, is that "it's hard to know ahead of time how sick a patient really is."

Jan Towers, director of health policy for the American Academy of Nurse Practitioners, said such criticism is off base. Nurse practitioners, she said, are well qualified to provide routine medical care. Many nurse practitioners already are providing similar medical services in doctors' offices and other care centers.

Nurse practitioners typically have a four-year degree as well as a master's degree in nursing, and in most states they can diagnose and write prescriptions like any family doctor. Still, under law, all clinics must keep a doctor on call during business hours.

If a patient arrives with more complex symptoms, such as pain in the abdomen or a stiff neck and fever that possibly signal meningitis, or if they come back with a recurring problem too often, nurses refer them to their primary care physician.

Jill Ryder, of Baxter, Minn., took her 2-year-old daughter, Elizabeth, to a quick-care center in a grocery store last month while away on a family trip. A few hours after leaving home, her daughter became cranky and appeared to have a fever. Ryder suspected an ear infection.

On a family member's recommendation, they stopped by a MinuteClinic nearby. Fifteen minutes and a $15 co-payment later, the nurse discovered Elizabeth had two ear infections. Ryder filled the antibiotic prescription at the store's pharmacy. "I am so glad we brought her in. Otherwise, we wouldn't have slept for two more nights," Ryder said.

Like some other companies in the field, MinuteClinic uses a computer software system to guide nurses through treatment recommendations and minimize the potential for errors. The software uses established medical protocols to help nurses diagnose common illnesses and recommends what drugs to prescribe.

The idea of providing low-cost and convenient medical care in unconventional locations isn't new. Two decades ago, stand-alone medical clinics -- dubbed "docs in the box" -- sprang up in malls around the country. But many soon went out of business because of high overhead costs -- they typically employed dozens of people, including costly doctors -- and an inability to differentiate their services from those offered at regular doctors' offices.

In contrast, the new clinics are housed in small spaces, some no larger than a small bedroom, and are staffed by one or two nurses. Most don't treat children younger than 18 months or people with chronic diseases, such as diabetes and heart disease, because of the possible complications.

Clayton Christensen, a professor at Harvard Business School who studies medical economics, said the new quick-care clinics may be here to stay. As many hospitals and doctors get better at treating more complicated problems, they're growing less able to keep costs low on routine services, such as routine physicals and flu shots. At the same time, waits in many doctors' offices and emergency rooms are growing, making in-and-out medical clinics more attractive. "What these clinics treat covers 80 percent of the reasons people go see their doctor," Christensen said.