A Response to Medical Ethics and Retail Clinics
The thoughtfulness evident in abundance in Thomas Heyne’s Bander contest essay by itself makes it worthy of the 2011 prize. We cannot, however, escape its pervasive elegiac tone, infused through Mr. Heyne’s peculiarly dated examples of ways in which physicians might respond to patients’ failure to abide by their doctors’ advice to “have a regular medical home.” Mr. Heyne suggests in one prominent example that such a contrary patient might, here in the twenty-first century, “maintain a portable record...documenting the retail visits, or (better) that the patient have the retail clinic fax all documentation from each visit (as recommended by the AAP)….”
Space prevents me from suitably elucidating the problems I have with this or other specific examples. Lacking such constraints, I might digress on the central role of EHR in retail clinics’ business propositions and processes and then contrast it with the diffident attitude of many physicians’ professional organizations towards this class of emerging tools for accumulating, assessing, and appropriately sharing actionable health care information with patients and those who care for them.
Happily, I can instead summarize my disbelief and dismay thus:
Early in his essay, Mr. Heyne reminds his reader about the primacy Osler placed on knowing “what sort of patient has a disease.” He thereby stresses the importance of a fine appreciation of context to the eventual value of a physician’s ministrations. Later, Mr. Heyne seems to disregard that reminder, himself; he appears uninformed about the context of contemporary practice that, according to the Bander scenario, has to contend with the ethical “disease” posed by retail clinics. In a world where soon over 80 percent of physicians will possess a smartphone (the better, presumably, to access the latest medication and clinical references—but not to improve their processes for managing and distributing information to patients), we should be ready to forgive those doctors who cock a quizzical eyebrow at one or more of Mr. Heyne’s ethical prescriptions.