beach doctorMy daughter and I went to the beach at Gulf Shores for a get-together to welcome the new residents. We had about 20 people, swam in the water (with the jelly fish, much to the dismay of some), played wiffle ball and football, and in general had a lot of fun. Fortunately, no one was hurt or became ill. Had that happened, I noticed on the return trip to Mobile, we would have had ample opportunity to seek care. There were 3 urgent cares, 3 IMMEDIATE CARE (turn here)s, and an emergency room with a NO WAITING sign out. If we were hurting but unwilling to pull over, there was a large billboard for a Pain Management specialist that we could presumably call on Monday.

When I was in the Navy I ran the urgent care on the base at Kane’ohe for a couple of years, so I have a little experience in the business. Because we were near the beach, I saw my share of stingray injuries (a stingray never intends to harm a human, it is the human who blunders into the stingray’s home), jellyfish stings (viscous lidocaine works better than pee to stop the sting), and surfing related injuries. The way the military worked at the time, everyone with an ID card got access to care with no co-pay, the only limitation seeming to be proximity to the urgent care when the symptoms occurred. There were children, I swear, that said “I’m” to their mother in the middle of the bowling alley, and were signed in at our desk by the time they said “sick.” I hope they racked the ball (as some were still wearing the shoes). It became clear to me that some barrier needed to be placed between the patient, the patient’s mother and the care provider (me) to force mom to interpret the symptoms prior to signing in. Of course, the Navy paid me not per patient, but with a salary.

Our university tried to get into the “urgent business” in a small way a couple of years back and began running ads that said “Feel Better Now.” A 90-year-old man showed up and told the doc (one of my colleagues), “I just feel bad and really want to feel better.” Turned out, he was being treated for a cancer of some type and was seeing a slew of doctors. He didn’t leave feeling better, and the ad campaign was scrapped. Of course, my colleague was also being paid a salary.

There has been a proliferation of care options for the worried well such as “urgent cares.” There is little evidence documenting their impact, but anecdotal evidence that folks are more likely to get prescriptions for unneeded antibiotics and are unlikely to get chronic illness care or appropriate follow-up for behavioral problems (if they come in falling-down drunk, for example, they’re treated for injuries sustained in the fall, but not followed for alcoholism). Urgent cares contribute to the medicalization of society, and Americans are already terrible at deciding when to access health care. We tend to spend not enough money on prevention and too much on care, and do it in collusion with the doctors manning the urgent, immediate, and emergent cares on Gulf Shores Highway appealing to folks with that good insurance driving home from the beach.

Every time you walk into a doctor’s office, it’s implicit that someone else will be paying most or all of your bill; for most of us, that means we give less attention to prices for medical services than we do to prices for anything else. Most physicians, meanwhile, benefit financially from ordering diagnostic tests, doing procedures, and scheduling follow-up appointments. Combine these two features of the system with a third—the informational advantage that extensive training has given physicians over their patients, and the authority that advantage confers—and you have a system where physicians can, to some extent, generate demand at will.

Next time you are driving past the neighborhood IMMEDIATE CARE, think about our health care mess and realize that in providing unlimited access for some we are queering the deal for many others. Unless, of course, you want an alternative to having your jelly fish sting peed on.