Convenient Healthcare vs. Scheduled Healthcare - What's Lost?
A recent segment of the Today show focused on the growing trend of walk-in health care clinics for people. These are the ubiquitous “Minute Clinics” found amidst local pharmacies or the 24-hour “No appointment necessary” offices where people can, at the initial fleeting sign of a sniffle, ache, or strange skin rash, show up and request immediate care for their ailment.
The report indicated that more and more people are pursuing the option of convenient care because of a perception that their primary care doctors are inaccessible during evenings, weekends, or holidays. However, with a bit more probing, evidence revealed the issue wasn’t that people couldn’t get in to see their doctor. The issue was they couldn’t get in to see the doctor when it was more appropriate for their own personal schedules.
I paused to consider the message put forth and what this suggested regarding American society’s awareness of the importance of their own health compared to the quality of life for their physicians, and (as usual) how does this information about human healthcare relate to my life as a veterinarian?
Few people would disagree with the notion that if you’re truly sick you should not be working. You should be at the doctor, or resting and healing your body, or both. Unfortunately, this simply just isn’t an option for many people trying to sustain themselves in our “Work to Live” society. It’s terrible to think people are so financially strapped or so worried about their job security that they literally can’t afford to take a sick day to go to the doctor when they are ill.
The flipside to the American status quo is that if people are unable or unwilling to miss work to visit the doctor, or their jobs are too important to take time off when sick, the natural expectation is that their physician should work second shifts or provide weekend or holiday hours to care for them when they are not working. Otherwise, doctors run the risk of losing patients to walk-in clinics with more convenient hours, even when this means the care offered may be impersonal and subpar.
As a doctor who also happens to be a human being, I support the notion that physicians should not be expected to work until midnight or be available every weekend or holiday, simply because their patient’s job or financial situation doesn’t allow them to take time off to take care of themselves. As a human being who also happens to be a doctor, I understand how difficult it can be to miss work because I’m sick and need to take care of myself and how it would be much more suitable to schedule my own appointments when my day was finished.
Most pet owners have a primary care veterinarian they will see for routine healthcare and preventative medicine, or for when their pets are sick with a non-life threatening condition, or even for emergency care. These same doctors recognize the importance of providing evening and/or weekend appointments to accommodate the restricted schedule of the average owner. Yet for smaller and personal veterinary offices, it’s completely unrealistic to expect them to remain open every hour of the day, 7 days a week.
You may be fortunate enough to live in an area where you have access to emergency veterinary hospitals which operate after hours and on weekends, or, in some cases, that are open 24 hours a day for the times where primary care vets are not available or able to squeeze your pet into their already overbooked appointment schedule.
The gray area in veterinary medicine opens up when we consider those hospitals where the policy is to simply get the case through the door with the “Minute Clinic” mentality. At first glance, it all seems like a win-win, as pets receive the care they need in a timely and efficient fashion. What may not be immediately evident is the great deal of pressure “convenient” healthcare puts on pet owners, and how that trickles down to potentially less effective care for their animals.
This Minute Clinic mentality can be especially problematic in “tertiary referral” hospitals where veterinary specialists such as myself work. Obviously, when life-threatening illnesses affect animals, or when access to specialized diagnostic and therapeutic equipment is required to save a pet’s life, accessibility is paramount.
But what about cases where waiting a day or so would not affect the clinical outcome but is more opportune for an owner, or for their perceived urgency regarding their pet’s care? What about the times when seeing the case on an urgent basis actually means fewer options may be available in the long run? Does the perception of “I can have it for myself, therefore I demand it for my pets” really play a role in the veterinary profession?
I’ve had countless referrals that “needed” to be seen that day, where owners show up without their medical records, without results of previous diagnostic tests, and without the right information to indicate why they are even sitting in my exam room in the first place.
The lack of a previously established client-patient relationship at such offices could at a minimum mean spending owners' money on repeating tests that were already performed, to the more serious error of putting forth a quality of medicine that is less than ideal, all the way to the worst case scenarios of grievous errors in medical care that could further harm the patient or even lead to their death.
Accessibility doesn’t always equal good medicine, and convenience doesn’t always equal compassion. This is important to keep in mind not only when considering decisions about your pet’s health, but also the next time you don’t feel well and have to decide about whom to entrust with your own wellbeing.
In both cases, it may just serve you well to pause to consider the bigger picture and take time to heal properly rather than settle for the most convenient option for your care.
Dr. Joanne Intile