I Don’t Care What Doctors Say – I’m Still Bringing My Kids To The Grocery Clinic

shutterstock_146375258The lameo-s at the American Academy of Pediatrics have released a new statement saying that retail-based clinics are an “inappropriate source of primary care,” and that “The AAP strongly feels that the medical home model of care for kids is best,” which doesn’t bode well for me and many other parents who use grocery and drugstore based clinics for many different reasons. The article, reported by NBC News,  explains the reasoning as most of these clinics are staffed by mid-level medical providers and nurse practitioners and kids may not be receiving the best quality of care if you take them there.

I have a normal pediatric group that my kids see for big things, but I’d be lying if I didn’t admit that this winter we’ve been dropping into the quick clinic at my local grocery store that recently opened. The hours are much better, it’s convenient, it costs less than their normal pediatric practice, and when you have a kid with something simple like an ear infection or pink eye it’s so much easier than sitting in the sick kid’s waiting room for an hour to get seen. And it doesn’t really matter anyway, because the quick clinic always tells us we should have our kids seen by their normal doctor for a followup anyway. Plus, having it located in our grocery means I don’t have to make additional stops to get a prescription filled and load up on juice and soup and ice cream when my kids feel lousy.

 

A clinic visit may also be less expensive than a trip to the pediatrician, according to a 2009 study that found that retail clinic costs ran 40 percent to 80 percent lower than the same visits to doctor’s offices, urgent cares or emergency rooms.

That same study, conducted by RAND Health researchers and published in the Annals of Internal Medicine, found that the quality of care was just as good at the retail clinics as at the other venues.

 

The article states that the America Nurse’s Association released their own statement which in part read:

“The latest policy statement from the American Academy of Pediatrics is just another attempt to preserve the status quo

 

I think this whole warning thing about parents visiting these quick care clinics is pretty insulting too, because I think most parents know if their kids don’t show signs of improvement in a day or two or if they get worse they should take them to their normal doctor or to the emergency room. I’ll still use our big practice for things like checkups and vaccinations, but if it’s five o’clock on a Sunday night and my kid says their throat hurts, I’m taking them next to the produce department so they can get seen instead of waiting a day to see our normal doctor.

(Image: Tupungato /shutterstock)

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    • Bethany Ramos

      Fuck that noise! We went to urgent care on a Sunday for a toddler cough (prone to pneumonia), and they were all sketch about being in our network and charged us $500!!! I have so much bitterness about this kind of stuff. I’ll take cheaper care out of a van in a parking lot – or grocery store – any day.

      • http://Mommyish.com/ Eve Vawter

        Van clinic!

      • Lee

        Holy shit! That is insane! Our visits to any urgent care cost a $35 copay.

    • Kay_Sue

      Here’s my POV. Of course, I say that, but you already know it, because this is my comment, so there’s that.

      I use (well, used, because they CLOSED DAMMIT) my sons’ pediatrician for big things and for check ups. I did this because I had a relationship with her, and she was awesome. This is the truth. She always took my concerns seriously, but had a great manner for talking me down when I was in that new mom “oh my god anything and everything could kill my child” stage.

      That being said, the office is (was–DAMMIT) always full of kids and adults waiting to be seen, it was difficult to get appointments on the fly, and it was trey expensive, which means that a handful of times that our insurance info was confused or messed up, and I got the bill, I had a minor stroke. So I too have been known to head to the nearest Minute Clinic for small things. It’s cheaper and quicker and easier. And as long as my kid gets healthy again, I refuse to feel guilty for it.

      We used an urgent care center for to patch my kid back together. There was a nurse practitioner on duty, and you know what? She glued my son’s forehead back together, provided medications, and, aside from a small scar that he says helps him “get the ladies” (I swear to all the feminist gods, I have no idea where he got that from), he’s none the worse for the wear from it. She was professional and courteous, and she did a damn fine job with a panicking mom, a dad trying to keep from laughing at panicking mom, and a kid that was bleeding all over her exam room. I give her mad props. So on that basis, I kind of take issue with the idea that nurse practitioner automatically means substandard care, too.

      • Natasha B

        Our peds practice had a nurse practitioner for awhile, and we loooooved her. She was often more available, she had more time to chat/address concerns, and she was very friendly and thorough while being professional. I actually preferred her over our regular peds.

      • Kay_Sue

        It’s one of those things where it should be the *person* that’s important, not the position, you know? There are great doctors, and then there’s the one that couldn’t diagnose a UTI for me one time, resulting in me nearly being hospitalized…yeah, he wasn’t very good at his job, because that should have been a no-brainer. I figure it’s the same with nurse practitioners. Some are good, some are bad, some are in between…

      • Natasha B

        Yep, like the urgent care physician at a reputable hospital who diagnosed me with heartburn….when I actually had a pretty nasty case of pneumonia. GENIUS
        that’s why when I find a dr I like, I stick to them like glue.

      • Tinyfaeri

        Oh, super glu. Just make sure the tube hasn’t been sitting open for a while (it slows the drying time) and you can do it yourself! If you do happen to only have an older tube on hand, prepare to have a bit of bandage stuck to you for about a week til the skin grows back and it falls off. Not that I speak from experience.

        And I agree on the NPs and also Physician Assistants – I used to work with some PAs and an NP that were wonderful care providers. It’s still nice to have a doc around for big or really complicated things, but they can still do some pretty fantastic work. And there are doctors out there that suck – like the DO who thought she was draining my kneecap, but was really draining one of the bursa. Or, poking multiple holes in it, either way. I mean, it drained into my foot…

      • Kay_Sue

        I think I could do it to myself, but I don’t think I could do it to my kid. Even knowing–absolutely *knowing*–that even shallow head wounds bleed like a motherfucker, I was good for just a little more than holding a t-shirt to his head and keeping calm enough to keep him from freaking out, lol! ;)

        Ouch on the draining into the foot. That does not sound fun at all.

      • Tinyfaeri

        In hindsight, it was actually kind of funny. I had a normal size foot and a giant Shrek-esque foot, and it went away in a couple of days.

        And yep, head wounds bleed like a sonofabitch. And it’s good to get checked out to make sure there’s no concussion, anyway.

      • Alex Lee

        Regular Super-Glue (ethyl cyanoacrylate) will sting and burn REALLY BADLY on an open wound while it dries.

        Medical glue (i.e. Dermabond / octyl cyanoacrylate) is formulated with less toxicity and lower potential for allergic reaction.

        Put the KRAGLE down.

      • Rachel Sea

        I always use super glue on fine cuts where a bandaid is impractical, and it never stings.

      • http://Mommyish.com/ Eve Vawter

        hee hee the kragle

      • Tinyfaeri

        And when you’re in the middle of nowhere and have a head wound that you would like to stop bleeding, it’s good in a pinch. And in that case, it’s better if it’s freshly opened, and hasn’t been sitting on a shelf for a while. But yes, medical-grade anything is almost always better than the liquid equivalent of duct tape. Unless it’s a wart, and then duct tape is actually not so bad.

      • AugustW

        I’m so thrilled to have learned to suture this last week.

      • Bunny Lucia

        Yeah, I don’t even see my doctor. I see my Physician’s Assistant when I need to go in.

        I absolutely adore her, we gossip about EVERYTHING and she does just as much, just as well, as my doctor.

      • Kat

        My insurance got screwed up while on my leave (I really deserve a gold star for not losing my ish on anyone in HR) and we had to self-pay a few visits. Dear. God. Above. $200 for 10 minutes with the doctor and that didn’t include the cost for the thing prescribed to treat the reason for the visit. Healthcare in this country is BEYOND messed up.

      • Kay_Sue

        Oh, I really feel this. I was in a car accident last May. Spent three hours waiting to be seen in the ER, then the doctor spent about five minutes in the room, shined a light in my eyes, and said I was good. I was presenting at the time with nausea, ringing in my ears, and a persistent headache. That was it. Next day, I went back to the doctor because the headache that wouldn’t go away–concussion. That first visit? $844. I got that bill and was like…uh, no. So glad I got to forward it on to the insurance of the person that hit me….

        Healthcare is *beyond* ridiculous. I applaud you for not losing your shit on HR, because I would have. I did, actually, when my boss screwed up some paperwork that meant I missed my first paycheck while on maternity leave. It wasn’t their fault, it was his, but they bore the brunt of my hormonal anger. I feel kinda vaguely bad about it now….

      • AugustW

        Form the first two years of her life, my daughter managed to ALWAYS get sick or hurt on Sundays, when her doctor was out. We spent a lot of time at the Urgent Care.

    • Williwaw

      Right now a walk-in clinic is our only option because in the suburb we moved to, it is impossible to find a GP who is taking on new patients! Given that we live in a large Canadian city, this is ridiculous.

      • Shea

        Yep, there’s a severe doctor shortage in my province, so if you want to get a GP, the procedure is to apply, wait for 2 years, then be told that your CLSC lost your application and they’ll have to put in a new one. I just go to the walk-in clinic. Whatever.

    • Kelly

      It’s nice that the AAP completely ignores the fact that many families can’t afford health insurance or doctor visits and these clinics are the only way they can afford to get treatment for their children.

      Seriously, can people stop being ignorant about those facts? WTF are people supposed to do if they can’t afford to go to the doctor? The alternative is to go to the ER and run up a huge bill and just not pay it. Is that better somehow?

      • Natasha B

        Yep, exactly. That’s pretty much our position.

      • shel

        Sadly, some people can’t afford these kind of clinics either, so the Emergency room with zero copay is where they go…
        Our healthcare system is jacked up (and was way before Obamacare).

      • Natasha B

        I have honestly seen so much of that….we were waiting in the ER when my daughter broke her elbow…and saw about 5 diff kids there with just colds or an ear infection. It’s just, insane.

    • TngldBlue

      We use the Urgent Care that is associated with our group of doctors/hospital because our pediatrician, much as we love her, is closed on Thursdays and guess which day our daughter ALWAYS get so sick she needs to see someone?!?! Our pediatrician doesn’t like it but come on, if you’re going to have 9-5 hours and be closed one day a week what is the alternative? Take her to the ER for everything until our insurance starts billing us (which they do if they find your ER visit was not truly emergent)? If the Urgent Care wasn’t open pretty much all hours, I’d use a minute clinic in a heartbeat. I know what pink eye, UTIs, etc look like and that all she needs are the drugs man.

    • Lauren_Alli

      I use my GP for everything right now for two reasons. #1 Our walk in clinics are germ-infested waiting lines and the care is, in a word, subpar. #2 My GP has alwasy been able to get us in within a couple of hours from when I call, and I adore her. She is so nice and caring, and never makes me feel like I am wasting her time. I can see how Pediatrician’s would be busier and walk-ins would be necessary, had I gone that route. It also costs the same either way, for me.

    • Alicia Kiner

      We don’t have any of these pharmacy or grocery store clinics where I live, but we have a few urgent care clinics. I will tell you, I will take my kids there on weekends, and evenings, but I call their regular ped first to see if they have anything available on weekdays if they’re home sick from school. I would prefer they see their ped, but the practice is staffed with several very good doctors, so they’re always busy. When it comes to sore throats, ear infections, and pink eye, the urgent care is faster for what we need. For everything else, we see the ped.

    • Natasha B

      Our kids are uninsured -family insurance at hubs work monthly premium is more than our mortgage (as in, 4 digits) plus a $2500 deductible. He makes too much for us to qualify for ANY kind of free/assisted healthcare, and any independent insurance carriers (yeah, thanks no thanks Obamacare) is still $600 plus monthly with a minimum $5000 deductible and ridiculous co pays, and half the time ER visits aren’t even covered (y’all ever read that damn fine print?!). So we plug a certain amount monthly into a separate account and that is used for medical/dental/vision. The kiddos do their well child visits at their peds, and get all immunizations there also. And we pay cash. BUT, when it comes to a cold/ear infection/something small….you best believe we hit up the CVS minute clinic. I love that place. It’s clean, the dr is courteous and thorough, there’s almost no wait time, and I can get the prescription right there. So, get over it AAP.

      • http://Mommyish.com/ Eve Vawter

        omg FFS, that is some baaaaaad insurance UGH

      • Natasha B

        It’s disgusting. They changed it when our son turned 2, 6 months after he was diagnosed with his condition and we had just completed his first round of tests. I sobbed for days, like wtf are we gonna do?! But it’s all good now….his peds actually gives us a cash discount so that’s somewhat helpful.

      • Kat

        Healthcare in this country is a damn disgrace.

      • Natasha B

        It’s a total hot button for me, but I honestly have no idea how to fix it. It will be…interesting….to see where the next few years lead healthcare.

      • Kat

        My best idea boils down to: catastrophic event (plague, zombie attack, alien destruction, etc.), society collapse, rebuild the whole thing from the ground up. Honestly, I see no other way.

    • Crusty Socks

      This is stupid. I don’t see anyone going to Walgreens for cancer treatment. For everyday minor injuries, common flu symptoms, etc, I think it’s fine.

      Spinal cord injuries, maybe not.

    • Tinyfaeri

      It’s nice to have a primary care doc who knows you, can see patterns, etc., but as long as all the records from the grocery store clinics are sent to them, I don’t see why there would be a problem with going to them for a minor problem, especially if they’re cheaper.

      • shel

        That’s the problem we see, in that we never get any sort of records from these types of places (in our area, anyway) which can be problematic for kids who are seen a lot or put on medications a lot.
        But the definitely exist for a reason, and kids don’t always get sick during business hours. That’s part of why we have a nighttime phone service where you can reach the pediatrician on call (though we don’t do meds over the phone), and we have weekend hours.
        I don’t begrudge the convenience aspect, and I really wish cost wasn’t part of the problem… All the AAP is saying is that if all of your medical care is coming from these clinics, which for a lot of children, it is… then your child probably isn’t getting the best care.

      • Tinyfaeri

        I would imagine all of the clinics have some kind of release of records policy, so some of it’s educating parents to make sure a ROR form is completed to share records with the PCP. I used to work as support staff in a non-prof family practice clinic, it’s not like the ER or hospitals are that much better about sending over records unless a doc office requests it, or they’re on the same computer system. We’d have to call all the time to get things faxed over for follow up visits. New computer-based systems work provided that your PCP and your urgent care provider are in the same network, but I would imagine there’s still some faxing and mailing involved.

      • shel

        I guess I simplify things in saying they don’t send records, but it’s also very difficult, if not impossible sometimes for us to obtain those records even with signed releases and phone calls/faxes. Or we don’t know patients were even seen to know we need records.
        That’s more of an issue with the walgreens/CVS type places, since they aren’t affiliated with a health system. Our clinic has mutliple urgent cares,so those notes are available in the computer system, it’s the outside vists that lead to more communication troubles.

      • Tinyfaeri

        It’s equally about patient education – they need to know that you aren’t automatically getting those records, and that you need them and why it’s important for you to know when they’re seen anywhere, and for what. That is up to you and your staff, and just part of running a primary care practice.

        And trading medical information between any networks is always difficult – it doesn’t matter if it’s Kaiser Permanente to XYZ Care or Walgreens to a PCP’s office. Until there is a centralized, national medical records database, it’s always going to be a pain. That’s why doctor’s offices have support staff, to track down that information.

    • Toaster

      I’m lucky to have a family doctor, as there’s a large chunk of people in my small Canadian city that don’t. Their after-hours answering machine tells you to go to emergency if you need immediate medical assistance and then hangs up. It can take weeks to get an appointment and the other day I waited for an hour with no end in sight before finally giving up and rescheduling the appointment (for early another day, to avoid the backlog).

      So yeah, you’d better believe I take my kids to the clinic when I need to! I was so happy when a second clinic opened in town because for a while we only had one and the hours are a little weird.

    • shel

      While urgent cares and these types of clinics do serve a purpose, and are often more convenient, the AAP is just pointing out that they aren’t necessarily the best place to get all of your medical care.
      I’m sure the quality is variable (just as I suppose the quaity of your peditrician could be variable) and I honestly don’t know the regulations they have as far as malpractice etc. Do the minute clinics do any billing related to insurance, or do the just charge a flat fee?
      The concern from a medical perspective is the loss of continuity of care. These clinics do not send information to your regular doctor, so when you then come in to see us because your child’s ear infection isn’t better, we don’t know which medications they have been on/ for how long/ how many different times etc. (and while we ask for that information,you’d not believe how many times we get “um… he’s had a few ear infections in the last couple months… I don’t know what they said his diagnosis was, the medicine was pink (lots of medicines come in the yummy pink stuff) I don’t know how much he got etc.)
      And all of the rapid strep results (or whatever tests results) aren’t given to us. Knowing that someone has tested positive for strep once or twice vs 5 times in the last 6 months does make a difference. I completely understand that sometimes it’s just much easier to go to urgent care… and unfortunately, I would like to live my life so I can’t have hours from 7am to 8pm every single day. And I think it’s reasonable to use those after hours type of things if it’s not every single week and if you have a kid who’s otherwise healthy… but it’s not without it’s risks.

      It would be less of an issue if they documented better and communicated with pediatricians…. and then there is also the concern that non-pediatric medical personnel just don’t have as much knowledge about pediatric specific problems.

      • Rachel Sea

        That’s why medical records need to be fully computerized. Doctors should be able to share without the family having to be a repository of medical knowledge. When my great-uncle was alive there were about 4 of us who had his medical record and med list memorized, because otherwise a doctor could easily kill him. That’s a stupid system.

      • shel

        I definitely agree, and things are getting better with EMR… there is a lot more we have access to between hospital systems then we used to, but i think clinics like the ones this article is talking about will be the last to come on board.

      • bookworm81

        The no records issue varies too. When we took our son to an urgent care clinic a few months ago (he busted the back of his head open) they took his pediatrician’s information and specifically asked us if we wanted them to send the medical records over (which we did of course). I can’t imagine they behave differently if it’s an ear infection or strep throat.

      • footnotegirl

        Every time I’ve gone to the MinuteClinic, the info has been sent to my doctors office. I know this because it gets brought up in my regular appointments. I also get paper copies of EVERYTHING in a little folder every time we go, which I save and bring to doctors appointments. I would LOVE to go to our family practitioner every time I have had a cold that’s lasted too long, or think I may have strep, or my daughter has been pulling at her ear and crying, but I can’t wait three weeks when those things happen, which is the minimum to get in to see her. I get about the same care at MinuteClinic as I would at the urgent care thats attached to my doctors practice, but with much longer hours, a much shorter wait, and much cleaner and less crowded waiting area where my daughter isn’t being exposed to god knows what other diseases while waiting to get looked at. Also, the urgent care doctor at my doctors office midiagnosed my daughter’s Hand, Foot, and Mouth disease as a ‘rash due to skin sensitivity’ while the MinuteClinic NP got it right with one glance (after it had spread to me).

    • Jem

      the town I live in has no walk in clinic (none. nothing) and it is not a small town by any means. Also, I don’t know why they make it seem like it is really easy to get an appointment with a pediatrician. If my son wakes up sick, and I call the doctor for an appointment I usually get told that the earliest is 4 months from now.

    • Guest

      I had a friend who HAD to take her kids here if she wanted to get anything done. They had to pay cash and couldn’t afford squat. When she tried to take them to the Drs, they were told they’d have to have pay for and get their wellness visit before they could even look at anything regarding them being sick. She couldn’t afford to do both.

    • Valerie

      I don’t think I know of anything like this where I live. If I did, we would surely take advantage. Although things are better now that we are a few years deep into the facility daycare petri-dish of disease, there was a time where I felt like we LIVED at our pedi’s office. Those fucking co-pays (and scripts) add up quick. If there were a cheaper option at the time, I def would’ve taken it. You know, as long as it’s not staffed by Doc McStuffins or whatever.

    • SA

      My husband and I use the minute clinic when we need to. I won’t use it for my daughter though. She is still too young for me to want to take her somewhere that wouldn’t have her medical records and risk not getting medical records sent back. We have a walk-in clinic at her doctors until noon each week day and a doctor that will get back to you on the weekends.

      I’m sure we’ll use it as she gets older (when she can better communicate her symptoms). I definitely understand the reasoning behind the recommendation though, it is better to have a doctor with complete understanding of your medical history and who is familiar with you, just isn’t always possible.

    • Gretta

      My kids pediatrician is nice enough, but his office is a madhouse. He is often running late. Once we are called back we are brought back and left to wait in one of the tiny exam rooms for a really long time. There’s nothing like being trapped in a tiny hot room with little kids. The hours of operation are M-F 830-500 so not all that convenient especially when my kids wake up sick Saturday morning. He is also expensive. The Urgent Care rarely has a wait. Their hours are better and they are open weekends. So whatever, if the AAP wants all kids to see a pedi all the time, they should look at the reality of being a parent.

    • Ptownsteveschick

      Well, at the practice where we can get my daughter seen, using her state insurance, there are only nurse practitioners and I think one doctor. It was that way at the last place too. So whatever.

    • TheGiantPeach

      I guess we don’t have these in my town, because I’ve never seen a clinic in a grocery store. My only options are my son’s regular Ped, one of several Urgent Care centers associated with our local hospital system, and the ER. One weekend while out of town, I did have to take my son to an “urgent care” that was not affiliated with a hospital and it was super shady. They gave my son a wrong diagnosis that caused him to need a hospital stay. Based on this prior bad experience, I don’t think I would be too keen on trying out a grocery store clinic even if they were available in my area. My son’s Ped is awesome anyway – they can always get us in that same day and the waits are always short, even for last minute appointments.

      • footnotegirl

        Luuuucky. It’s a 6 week wait to get in to see my family doctor (who is also our pediatrician). The alternatives are a 1.5 to 2 hour wait at the urgent care, the emergency room, or the clinic. Locally, we have a chain of places called MinuteClinic that operate out of CVS stores. They are invariably clean, well kept up, with short waits and clean waiting areas. The practitioners in my experience have always been thoughtful, realistic, and more than ready to tell you to go to a doctor if it’s something they can’t deal with.

    • footnotegirl

      When the wait to see a NP at the MinuteClinic is less than 10 minutes in a clean, spacious area without other sick people around, vs. going to the building my doctors office is in (where we will NOT see my doctor, but just some random doctor or nurse that my daughter has never seen before either) where we will wait for upwards of an hour and a half in uncomfortable chairs packed tightly with people who are sick from a wide variety of illnesses, and all I want to know is “sore throat or strep?” the choice is EASY. I am confident that the NP will pass me up the line to a doctor if things are too much for them to handle. They need to get out of their damn ivory tower.

    • footnotegirl

      Luuuucky. It’s a 6 week wait to get in to see my family doctor (who is also our pediatrician). The alternatives are a 1.5 to 2 hour wait at the urgent care, the emergency room, or the clinic. Locally, we have a chain of places called MinuteClinic that operate out of CVS stores. They are invariably clean, well kept up, with short waits and clean waiting areas. The practitioners in my experience have always been thoughtful, realistic, and more than ready to tell you to go to a doctor if it’s something they can’t deal with.

    • CW

      I went to a MinuteClinic last week to get a TB screening test because it was more convenient and much cheaper than making an appointment at the doctor’s office (we have a $1500 per person deductible on our current plan). If doctors want patients to come to their clinic rather than the MinuteClinic, they need to offer services less expensively and more conveniently.

    • SusannahJoy

      We have awesome insurance, so we mostly take our kid to the doctor for everything. Except for when he got sick when we were on vacation and we called the nurse hotline to get a prescription and consultation and they didn’t call us back for THREE DAYS. But the Longs or whatever that was down the street from out hotel was happy to help us without any waiting or anything.