If you're living with a chronic illness, you're in the right place.

Wednesday, June 5, 2013

Doc In the Box

4:16 PM Posted by Tiffany Taft , ,
I came across an April 2013 article about Walgreens drug store clinics starting to see patients with common chronic illnesses, such as diabetes or asthma.  I don't know about where you live, but around here Walgreens seem to be sprouting up everywhere, and many of them offer Take Care clinic services.  I've used the one down the street from my house to get a flu shot, but beyond that I have no personal experience with their medical practice.

Typically staffed by nurse practitioners (or advanced practice nurses), walk-in clinics - or doc-in-the-box as one of my former physician colleagues liked to call them - are becoming much more readily accessible in recent years.  There are many arguments for and against this medical paradigm, and the inclusion of chronic illness in addition to the typical acute conditions these clinics cater to opens up a whole new debate.

Or an advanced practice nurse.

Is it a good idea to manage a chronic illness at Walgreens? (Or any other walk-in clinic?)

In the article, family physicians argue against this primarily because of the relationship that is formed between the primary care doc and his/her patients.  I had to pause there for a second and think about my relationship with my PCP, who I've been going to since I was about 23 years old and came down with a nasty case of mono.  I don't see him too regularly, I'd say less than once a year.  I like him and he knows me, but do we have an actual relationship?  Our visits are usually pretty quick, definitely under 15 minutes.  If I added up all of the face-to-face time I've spent with him over the past decade and a half, it may equate to 3 hours.  There is a lot of research evidence to support the importance of this relationship, especially in managing chronic conditions. Do I have a relationship with him?  Not really.

Would switching to the Walgreens clinic down the street compromise my care for things I go to my PCP for?  I'm guessing it wouldn't.  Plus, it'd be orders more convenient as my physician is downtown, or a 45 minute train ride away.  But would I go to Walgreens for my Crohn's disease management?

I doubt they include Crohn's on their current list of chronic conditions they manage, but what if they did in the future?  Assuming my symptoms were well controlled, what would be wrong with going to that clinic for a vitamin B12 shot or to have my blood work checked?  I definitely feel like I have a relationship with my gastroenterologist, much more so than my PCP.  So I think going to the doc-in-the-box for Crohn's would be a little weird.  Part of me doesn't think it's a terrible idea, either.

I should also note that I have health insurance so I can afford to go to see the top-notch specialists in Chicago.  For those not as fortunate, maybe these clinics can offer a more reasonably priced alternative especially if the other option is to not go at all because you can't afford it; or to wait until you need to go to the emergency room because things are so out of control.  For people in Chicago without insurance, that means going to Cook County hospital (remember the TV show "ER"?) and waiting up to 12 hours, or going to a private hospital and hoping you can get the bills waived.  They've rebuilt Cook County since I went to the ER with a friend back in the late 1990s, but back then you literally took a number and waited for it to be called.  Like at the bakery.


What do you think about the use of walk in clinics for managing chronic illness?  Is this a good idea that fills in gaps in health care and offers convenient, lower-cost options or something that should be discouraged for more traditional models of care?  Would you use one for your illness?

Best,
Dr. T