September 11, 2012 | Posted By Jane Jankowski, LMSW, MS

Plans are underway at some drug store chains and other discount retailers to open in-store clinics which will offer an expanded menu of low cost vaccines and basic clinic services to consumers. Vaccines for flu and pneumonia have been available at retail locations for a number of years, and have become a familiar practice at drugstore chains and other retailers particularly during autumn when the newest flu vaccines are available. A folding table and chairs, consent forms, alcohol swabs and a sharps container typically wait at the end of often long lines of people seeking these prophylactic shots. More recently, several retailers began opening in-store clinics and current estimates of existing in-store clinics hover around 1,300. The pending expansion of these clinics may bring the numbers up to over 3,000 within the next 3 years. 

The self-proclaimed low price leader, Wal-Mart, plans to open independently owned and operated in-store clinics which will treat walk-in patients seven days a week. The list of services ranges from acne care and common vaccines to flu treatment (for those who missed the Wal-Mart flu shots) and upper respiratory infections. It seems reasonable to presume that other in-store clinics are or will be similarly equipped. For the millions of Americans who have difficulty accessing primary care, this may be a tolerable solution which falls somewhere in between going to the ER for these routine healthcare issues and having a primary care physician who can provide comprehensive on-going care. As noted in a piece printed in The Detroit News, the Affordable Care Act will thrust millions of newly insured patients into the waiting rooms of medical offices clogging an already strained primary care system. Perhaps the locating clinics in popular stores is a kind of outreach for clinic owners who  have been unsuccessful in efforts to provide care to underserved populations. I am not convinced these clinics represent such altruistic intentions. This expansion of medical services raises questions about whether or not this venue truly supports the best interests of patients.

I must admit, I don’t love the idea of sick people coming into a retail venue when they may pose a risk to well shoppers who might not otherwise be exposed to these ailments. But I am willing to suspend my germ-o-phobic tendencies to consider the model more objectively. Retailers are seeing an unmet need and finding a way to capitalize on the failings of our US healthcare system to supply adequate accessible healthcare for all. When generic drugs became available at dramatic discounts, the programs were wildly successful. Some have argued that these programs had an impact on national healthcare costs. Logically, though, clinics will bring people into the store. And consumers leaving with prescriptions can hit the pharmacy before they leave. Maybe some Tylenol, tissues, ginger ale, saltines, and a can of soup will make it into the shopping basket. It’s a win-win. Or is it?

The troublesome element is that this is all about commodities, not about quality patient care. The doctor-patient relationship is the least valued element. The provision of medical care remains a market good in this model. Establishing a rapport, taking a good medical history, and performing comprehensive exams do not appear to be included in the goals of these in-store clinics. Patients risk being objectified as consumers of vaccines, blood sugar tests, and strep swabs. If the medical needs exceed the scope of these clinics, the patient may still be unable to secure the care they need. For patients without primary care providers, particularly those with chronic conditions such as diabetes and hypertension, the continuity of care needs will still not be met. This group of patients seems likely to remain underserved. In fact the American Academy of Family Physicians has opposed the expansion of retail health clinics citing concerns about maintaining adequate standards for patient care. 

The fate of in-store health clinics is not yet known. Affordable, accessible healthcare is an important social good for any society, and while retail health clinics offer convenience and low cost, it is not clear they can provide quality patient care that meets acceptable practice standards. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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