"Fast-Food" Medicine

This article is not a plea for the public to avoid Costco telemedicine, Amazon pharmacy, or CVS mental health visits. If the services are readily available and affordable, they will be utilized. But, the important thing is that they are used appropriately, and I don’t believe that a majority of the public completely understands how to utilize these services yet. #medicine #healthcare #physicians #retail #Costco #Amazon #telemedicine

Reflecting on an Era of “Fast-Food” Medical Care

I recently read a LinkedIn post by Dr. Dana Corriel of “Doctors on Social Media” about “Here’s what I think of Costco bringing healthcare to its aisles.” It alluded to how medicine is being hijacked by corporations and how, “…doctors need to either buckle up or slide on over to the driver’s seat. Create our own practices. Market ourselves and what we bring to the table. Because our degrees matter, and we get to define that if we choose to.” It made me reflect on the state of what may now be an era of “fast-food” medicine.

The term, “fast-food” medicine, refers to cheap and easy medical care that is not necessarily the best for you…just like a fast-food meal. Fast-food restaurants deliver you food quickly and it is designed to taste good, but it is not ultimately healthy for you in the long run. However, you don’t realize it until you start gaining weight and suffer the adverse health effects years down the line. This “fast-food” medicine is supplied by successful retail businesses that made their mark selling a wide assortment of foods, clothing, books, pharmaceuticals, children’s games, batteries, and anything else that you could think of as a general consumer.

Retail Giants in Healthcare

While Costco is the most recent retail contender to enter the foray of healthcare with its primary care telemedicine, it has been a pharmacy, optician care outlet, and hearing aid distributor for some time. However, other retail companies have already settled into the healthcare space, besides Costco. Amazon provides Amazon Clinic as a platform to connect telemedicine partners with patients, as well as providing online pharmacy services. The drugstore, CVS, brought healthcare into their business by adding the “MinuteClinic” and also embarked on providing mental health counseling services. These services are not inherently bad, but they do have limitations and their breadth of expertise can be overestimated.

Financial Incentives and Increase in Telemedicine Use

The dash of retail companies running into healthcare may simply be explained by the financial incentive and the changes in the perspective on telemedicine. “Healthcare spending represented 18.3% of the US economy in 2021, with $4.3 trillion in revenue.” It is estimated that total expenditures are expected to increase to approximately $6.2 trillion by 2028. Furthermore, “…the total US telemedicine market size is predicted to reach $22 billion by 2025.” As the pandemic hit, there was a marked increase in telemedicine visits by 766% in the first 3 months of the pandemic, from 0.3% of all interactions from March to June 2019 to 23.6% of all interactions in the same period in 2020. It doesn’t appear that telemedicine is going away or decreasing in utilization anytime soon. Telemedicine and retail medicine do have a role in healthcare, but it is important to understand the limitations and indications for its use.

Limitations of Telemedicine and the Importance of Continuity of Care

Telemedicine does have its limitations. Anyone can diagnose a “cold” or hives via Zoom, but can a healthcare provider establish a pneumonia progression as a part of the “cold” visit or manage respiratory distress when the allergic reaction causing the hives evolves into lip and tongue swelling? Can telemedicine diagnose strep throat or a urinary tract infection without performing the appropriate lab test prior to prescribing antibiotics? Do these retail telemedicine services provide the continuity of care and expertise to manage someone who has questions or complications with a chronic illness, like diabetes or arthritis? I would argue that the answer is “no” because many medical encounters require an in-person evaluation to generate an appropriate diagnosis and management, whether it be because of the added physical exam or laboratory test. Furthermore, chronic diseases require knowing a patient’s extensive history to make an appropriate medical decision in a patient’s long-term management which is the definition of the coveted continuity of care principle.

Continuity of care relies on a long-term relationship between a healthcare provider and their patients. It is the cardiologist who performs a telemedicine visit with their known patient with heart failure and adjusts their heart medications or the pediatrician who assesses a child with developmental delay concerns that they’ve known since birth. These visits require prior knowledge and experience with a patient and their family. When a patient has fractured care by seeing different medical providers and medical providers who don’t have access to a complete medical history, inappropriate medical decisions can be made. These are the things that “fast-food” medicine is not very good at and can cost patients in the long run with their checkbooks and, most importantly, their health.

Nuances of Medical Care: A Problem for the Public

The problem is that the public may not appreciate these nuances of medical care. The systems, benefits, and drawbacks aren’t always transparent to the consumer. They, understandably, want to get well quickly, but may not know everything that is involved in providing the standard of medical care. As physicians, we all want that outcome for our patients and ourselves. However, the typical healthcare consumer may not delve deeper into the fine print of a retail medical visit beyond how quickly they can be seen and how cheap the visit is. In fact, Amazon has been quite adept in manipulating the consumer market to limit its competition by utilizing online strategies to reduce exposure to its competitors. It has done it so successfully that they are the subject of a lawsuit by the Federal Trade Commission for illegally maintaining monopoly power. If Amazon can do this with shoelaces and toothpaste, why wouldn’t they be able to do this with healthcare services? And, don’t even get me started with the potential of artificial intelligence being used by retail medical services. That is another discussion in and of itself.

The Path Forward for Non-Retail, Healthcare Providers

This article is not a plea for the public to avoid Costco telemedicine, Amazon pharmacy, or CVS mental health visits. If the services are readily available and affordable, they will be utilized. But, the important thing is that they are used appropriately, and I don’t believe that a majority of the public completely understands how to utilize these services yet. The point of this article is to appeal to the medical community to educate and advocate for appropriate care of patients and not be lost in the cyclone of digital advertising by large retail companies. A primary clinical practice cannot compete with the $29 virtual primary care visit that Costco is advertising. However, if the public can see the value of and has easier access to their primary healthcare provider, healthcare may stand a chance to withstand the attempts of the retail industry to make destabilizing incursions in the field of healthcare. It is like what Dr. Corriel said about physicians sliding on over to the driver’s seat. If we aren’t in the driver’s seat in medicine, we will be a passenger in a car going through the drive-through of “fast-food” medical care.

How do you feel about retail giants like Costco and Amazon entering the healthcare space, and what impact do you think it will have on the quality of medical care?