Is It Okay to Bypass Your Doctor?

Wish you could get your sore throat looked at as fast as you can get served a double macchiato? Retail health clinics feel your pain, which is why about 1,000 of them have sprung up in drugstores, shopping malls, and big discount stores. The idea is that they take care of you quickly; no hours of waiting around for the moment you can slip into your regular doctor's (already too busy) schedule. And they might be open on a Saturday when you have a raging sinus infection and your doctor doesn't have office hours.

Walk-in clinics have drawn more criticism (and sometimes, probably more praise) than they deserve from the medical establishment (although you do need to approach the clinics with some caution; more on that in a minute). Usually staffed by a nurse-practitioner or physician assistant, and most often with a doctor offsite who oversees several clinics to make sure the quality of medical care is up to snuff, they're a lot like walk-in hair salons: You don't need an appointment, the menu of services is bare-bones, and the prices are posted, so you know what you're in for. These days, many insurance plans pick up most of the cost, too.

Quality's surprisingly good. Recently, Rand Corporation researchers compared 2,100 mini-clinic visitors with others who went to a doctor's office, an urgent-care center, or an emergency room for an earache, sore throat, or urinary tract infection. Quickie clinics delivered slightly higher-quality care than doctors or urgent-care centers, at lower prices -- an average of $110 versus $166 for the family doctor, and a whopping $570 at the ER.

But before you head to one, you need to know that two trends are currently changing the clinic landscape. One is promising: About 1 in 10 retail clinics are now associated with a medical center -- even the Cleveland Clinic and the Mayo Clinic have had affiliations with a few. Nurses at MinuteClinics in northeastern Ohio, for example, can consult with medical directors at the Cleveland Clinic, which will now have some oversight at the mini-clinics. And the nurses have access to a patient's electronic medical records from the medical center and its doctors, which makes for smarter decisions about treatment.The other calls for caution. A few clinics are branching out beyond the small stuff. Texas-based RediClinic has added steroid injections for allergies, some antibiotics for infections, and acne treatment, for example. Some MinuteClinics, based in CVS drugstores, offer acne treatment. And at a few Take Care Clinics (Walgreens), a pilot program offers asthma and osteoporosis treatments to Medicare patients. Here's the issue: Chronic conditions such as asthma or thinning bones (osteoporosis) need ongoing checks of your health status and medications, and these should be done by your family doctor, who can help you manage all the factors that keep these potentially dangerous conditions in line.

Of course, where there's a trend, there's usually a countertrend. In part, as a response to the rise of these clinics, more and more family doctors are making room in their schedules to see walk-ins and are even adding more evening and weekend hours.

But if you choose one of these clinics, pop in for a visit before you need it, and find out whether the clinic accepts your insurance, how long a typical wait is, what ailments they tackle, and how late they're open. For locations of the largest clinic chains, log on to www.MinuteClinic.com or www.takecarehealth.com.

Then, insist that a record of your visit go to your primary care doctor. Don't assume every clinic forwards a report to your medical home base. Get a copy for your own records, too.

Mini clinics aren't mini ERs. Even if there's one next door, you still need to dial 911 for urgent problems, and head to the actual ER for chest pain, bone fractures, bad cuts or injuries, and other problems that seem serious. If you wonder whether you should go to the ER, chances are that you need to.