The Problem with doc-in-the-boxes

Ever notice the number of immediate cares and urgent cares that are popping up all over like mushrooms? It seems like a new one opens each month. They all have the same motif. Get your insurance. Get your money. Treat you. Street you. And back to your primary care doctor you go, better or not…

We consider going to these Urgent Cares and Immediate Cares a last resort for a patient. Here’s why. These clinics are staffed by hired guns; Doctor’s, Nurse Practitioners or Physician’s Assistants who get an hourly wage to staff the facility. Basically they get paid whether they do a good job or not. They have no vested interest in the clinic or in your treatment success, just the fear of malpractice. Worry about you once you leave the clinic? Not a chance. When you leave and they go home at night you are the last thing on their mind. Furthermore, these providers know nothing about you, your history and your idiosyncrasies. This predisposes to increased chances of a poor outcome.

Compare and contrast this to seeing your solo practitioner primary care doctor. Everyday we stake our livelihood on your treatment success. When we don’t make you well and lose your confidence as a patient, you are more likely to go find another provider. When that happens we don’t get paid and we starve. Thus everything we do in our office is absolutely in your interest and for your own good because that’s what’s in our interest. We would never do anything intentionally in our office that doesn’t lead to a good outcome because if for no other reason, it harms us. So do we worry that we are doing the right thing for you medically speaking? You bet we do because we are ALL IN. We worry incessantly about you. Everything is on the line every time we treat you. This creates a level of accountability that only a solo primary care practitioner’s office has.

Personally, we almost never use the doc-in-the-boxes because we believe they don’t deliver the best care. The one clear indication for having to use one is after hours when you need labs or Xrays STAT. After all, there are only two general places you can get after hours labs and Xrays: Urgent Cares and Emergency Departments. For all other complaints that don’t require STAT labs or Xrays, you should be paging your primary care doctor.

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I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.