Is the Patient-Doctor Relationship Still Alive? Yes.

Norman Rockwell vs. Walgreens Definition of the Physician-Patient Relationship

When I describe it, many of you will instantly recall the Norman Rockwell painting of a doctor holding a stethoscope to the chest of a little girl’s doll.

 

Historian Neil Harris described that iconic image, published in a 1929 edition of the Saturday Evening Post, beautifully: “Such a willingness to place professional expertise at the feet of childhood magic serves to remind us, again, of things we have forgotten: secret kingdoms inhabited by imaginary beings whose needs seemed as real as those of the people around us. Rockwell's physician may appear to take the doll's health seriously as an effort to gain the child's confidence and trust, but his act of sympathy is also one of grace, accepting his patient's needs with serenity."

It’s a classic American image, and meaningful in my profession.  Rockwell knew the importance of rapport between doctors and patients.

This week, Walgreens announced they will shutter 160 of their “in-store” health clinics to focus on other ways to bring consumers through their door, like partnering with Jenny Craig weight loss centers.

Retail clinics like those targeted by Walgreens are mostly located in drugstores, supermarkets, “big box” retail settings. Touted as a cheaper alternative to urgent cares and emergency rooms—early studies showed costs were 30% lower compared to care provided in more traditional settings—it turns out 58 percent of retail clinic visits represent a new use of medical services.  The study, published in Health Affairs, revealed the increased use of medical services obliterates any cost savings of utilizing retail clinics.

 

Retail clinics are accessible and convenient.  They are open from 7 a.m. to 7 p.m., seven days a week, and staffed by a nurse practitioner or physician assistant. They treat a variety of minor illnesses such as colds, pinkeye, and urinary tract infections, and provide an array of preventive services, like vaccinations.

However, retail clinics do not offer big profits for corporations or big savings for consumers.  But then again, is the practice of medicine a profit-generating machine or an art and science?

It depends on who you ask.

In one of the last conversations with my grandfather—a solo physician in Tacoma for four decades—he shared his dismay that home visits were no longer a routine part of medical care.  He admonished, “You will never be a good doctor if you don’t know the environment in which your patients live.”   He was probably right.

On the other hand, if you ask Walgreens, profit margins are prioritized over the art and science of healthcare.  And they are going all-in on comprehensive care for senior citizens. Jim O’Conor, senior vice president of Walgreens Neighborhood Health Destinations, said, “We are finding that seniors appreciate not just the high quality of clinical care, but also the social interactions, the personal attention, the convenience and the enhanced coordination between their pharmacist, physician and the health guides we have on site.” Walgreens and Microsoft are developing a “seamless ecosystem” to connect consumers to providers, payers and others. Approximately 200 retail clinics will operate through new arrangements with large health systems, to focus on complex issues and chronic conditions to make more money.

Such grand plans disregard the physician-patient relationship, which is a big mistake.  Rockwell’s painting still has relevance as today’s healthcare market is redefined.

Walgreens “seamless ecosystem” offers full-service primary care, pharmacy, nutrition, and wellness support.  Clinics will be staffed by physician-led teams, registered nurse ‘care coaches,’ behavioral health specialists and social workers.  The retail giants believe seniors will flock to “convenient neighborhood health destinations” where they can get healthcare services where they buy their salad dressing.  Target is teaming up with Kaiser Permanente, CVS—of Minute Clinic fame—is partnering with Aetna, and Rite Aid is working with a telehealth service provider to expand “virtual care” services. 

  

Is a Minute Clinic on every street corner really a panacea for the over-60 crowd?

One of the wisest women I have ever known was Millie, a neighbor and friend who lived well into her 90’s.  After her primary care physician retired, she asked for help to find a new doctor.  She was emphatic about having a physician who knew her name and cared to ask her opinion.   

Millie was not willing to get a flu shot at a retail clinic, so there is no doubt she would not seek care at one when she was ill.  In fact, I visited her home to give her the influenza vaccine myself over the years.  She would often speak fondly about the doctor she had as a child.  It is during one of those home visits when I first learned Millie had lost her father to influenza during the epidemic of 1918. 

It seems perverse to deliver healthcare services at a place called the Minute Clinic. The kind of physician-patient relationship that can be cultivated in a minute is not one to write home about. 

While CVS and Walgreens see geriatric primary care as yet another untapped gold mine, for me, the relationship memorialized in Norman Rockwell’s “Physician” resonates as much today as it did 90 years ago.  Seamless ecosystems are no match for a “willingness to place professional expertise at the feet of childhood magic.”

 

The bond Millie and I shared was magical.  And every patient deserves a physician who knows their name.