McDoc: Welcome to take-away medicine

19. August 2011
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In the U.S., a revolution has begun: For several years, so-called "walk-in medical clinics" have been spreading there. They assume the cost of treating "trivial" illness and give physicians competition. When will the revolution arrive in Germany?

1948 – Fast food sees the light of day. The McDonald brothers develop an innovative and efficient way of cooking hamburgers. The result: all over the whole world, the same quality, the same flavour. Now, in the U.S., diagnosis and treatment is being optimised, standardised and offered by non-medical practitioner staff at low cost. This is not medical excellence. This is the birth of “take-away” medicine.

Cheap treatments at any time

“Walk-in medical clinics” provide a new model for fast patient care. Placed in pharmacies and large shopping centres, at these clinics one need not make an appointment. They are open on weekends and evenings. Their service is limited to vaccinations the treatment of mild illnesses (such as acute sore throat or ear infection) and follow-up care of chronic diseases like diabetes, high blood pressure and high cholesterol. But above all, the costs are more than fifty-percent lower than for a normal doctor. All these services are provided by nurse practitioners.

Nurse practitioners in the U.S. are female or male nurses who have a command of additional specialist knowledge and clinical competencies for expanded practice. The majority of patients in the U.S. who go to these clinics are young (between 18 and 44 years), without insurance and do not have their own family doctor. Currently there are over 1000 “walk-in medical clinics” in the United States and these numbers are steadily increasing. Polls show that in the future about 19% of patients would rather visit one of these small clinics than go to their family doctor or an emergency clinic.

The first of these clinics was opened in 2000 and was immediately the subject of great debate. “Walk-in medical clinics” claim that they offer affordable help, particularly characterised by its high quality. These clinics are confident that they are not creating any new health system, but rather conform to the current one. “There are clear clinical requirements, for when one is to go to a doctor or emergency outpatients department,” says Web Golinkin, CEO of RediClinic small hospitals-chain. Although they can only make small profits through treatment, the clinics ordinarily nevertheless work to quality-assurance standards under the supervision of a physician. They also adhere to clinical guidelines and recommendations so that the care that is given in one, say in New York, is as much as possible the same as in one in Florida.

Doctors voice concerns

Nevertheless, some medical organizations, including the American Medical Association and American Academy of Pediatrics, have expressed concerns about the actual quality. By placing the „walk-in medical clinics“ in pharmacies, it could lead to excessive prescribing of drugs. Furthermore, a visit there could in cases of unforeseen complications lead to increased health care costs. Since there is no continuing care – as compared to the family doctor – it is difficult to act preventively. In 1948 as well, the success of fast food meals was celebrated, the outcome of which is looked at today in some ways with so much dread that policies and campaigns can only limit the damage. Fast food medicine, on the other hand, could potentially wreak even more damage.

Current studies stand in contrast to these legitimate concerns: In one study from 2009 with 2100 subjects it was able to be shown that there is no visible difference to registered practitioners in the quality of care. The question here is then: Are these clinics actually good, or are registered doctors plainly just bad?

Advantages for Germany?

Will the revolution in “medicine-to-go” nonetheless make it to Germany? In Germany so far there have been no similar services. Both diagnosis, as well as drug therapy, are monopolies sitting in medical hands. A change here could actually be advantageous. Currently overworked family physicians could benefit from this development, since patients with simple illnesses, for whom a clinical check would be sufficient, would only rarely still show up in person. Furthermore, it could lead to smaller economies in the health system via cheaper labour. But this should not be the deciding factor!

There are numerous ‘cons’ opposing these few ‘pros’. In Germany there is currently no equivalent to the education given to the Nursing Specialist. Interest groups continue to ensure that the historically open practice of medicine remains reserved for licensed doctors. While this does prevent rapid progress, it provides however for a high quality standard, around which everything most particularly in the health system is supposed to revolve. Finally, in Germany the necessary infrastructure is also missing, such as large pharmacies and pharmacies in supermarket chains, which are the common providers of the “walk-in medical clinics” in the U.S..

Conclusion

Revolutions can change everything, but they still need a ground on which they can come into being. The development in Germany of “take-away medicine”, at least for now, is most unlikely. What remains is the question of whether Germany will now miss a progressive step, or whether it will unintentionally contribute to maintaining the quality of the health system.

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