Wednesday, 18 Sep 2019

You are here

Jiffy Joint and Rheumatology Retail Clinics

The American College of Physicians issued a position statement about medical clinics popping up inside of retail establishments and pharmacies. Doc-in-the-box clinics, satellite clinics and now, retail clinics – it’s about going where the business is and bringing the zoo to the monkeys.

Recognizing that retail clinics are a reality, the ACP has embraced them and placed them in their deserved place. The ACP supports such retail health clinics found inside pharmacies and stores by stating they should be used as backups to the patients’ usual physician and clinic. That such “out posts” can be used to treat common ailments like “cough and earaches”. Many of these clinics are cash only (out-of-pocket) payments and others may be covered by insurance. (Citation source bit.ly/SQRXAa)

Furthermore, the ACP states that retail health clinics are also responsible for communicating the patients’ health care information to the primary care doctor. These retail clinics and their corporate managers have favorably accepted the ACP position and directives.

So this is an inevitability. On your next visit to Target you can expect to find boldly bannered cubicles housing the optometrist, Medstop (the retail store), Chiropractors Drs. Bend and Crack and the Law Offices of Cheatum and Howe (you may have heard, Dewey passed last year). But is there room for the most of common of ailments (arthritis) and the rheumatologist.

Rheumatology is ideal for this next great advance in healthcare. We have no gimmicks and have almost no space needs. Our needs are modest and skills are mighty. Moreover, retail rheumatology meets the needs (convenience, good hours, respectable hourly wages) of those looking for jobs – new grads, women in rheumatology, part-timers, San Diego surfer dude Rheums and semi-retiring rheumatologists. Who wouldn’t want a sweet little suite on Aisle 16 in Walmart (between paper goods and hosiery)?

Admit it – for every cough there are 7 aches; for every sinusitis there are 4 antalgic shoppers; and for every earache there are at least a dozen fibromyalgia rheumaticas. With nearly 60 million arthritics served in the USA, we should be as ubiquitous as McDonalds. The need for facile management of stock boy tendinitis, house-slipper bunions, and work-excuse lumbagos bolsters the need for an in-house rheumatologist. Nearly half of those shopping between the hours of 1 and 5 AM have fibromyalgia and I’ll wager good money that there are two or more gouts in every Walmart, at all times.

For years now I’ve schemed of starting a national chain of “Jiffy Joints”. With the support of the ACP and the big box stores, this could be a dream come true. If not located in Kmart or the mall, my Jiffy Joints can be easily housed in remodeled from drive-thru dairy/soda stores or those oddly parking lot Fotomats.

Download our app, fill out your info, check the right complaint box (“Sorry ma’am, only 2 complaints per drive thru”) and provide your credit card info. No appointment needed; if we are not immediately available you can either circle the lot, go to Orange Julius or wait in line. After all, the average visit will only be 6-11 minutes – with most of that dedicated to documentation, billing and prescribing.

Like dermatologists, rheumatologists are expert at pattern recognition, except they see 75 patients a day, and I’m exhausted after a dozen. Jiffy joints can be the one-stop shop for spot diagnoses (OA, gout, DeQuervains tenosynovitis) and quick testing (we would have to excel at dipstick and finger stick diagnostics). Jiffy joints are the place to go for expert shots. Many soft tissue and intraarticular injections can be delivered through a drive-thru window without the hassle of unbuckling and leaving the car. Think about it, you could just as easily inject the CMC1, carpal tunnel, olecranon or subacromial bursa, and even the knee (the driver's left or passenger’s right). Just swing it out the window, count to 10 and we’re done!

The formula for profitability in modern healthcare should include: a) low overhead; b) high throughput; c) profitable testing; and d) profitable treatments. Sure we can write a script and our patrons can skate 90 feet across the lot to Walgreens for their auranofin Rx. But why not focus on our own line of arthro-active compounds and Jiffy Joint branded products like:

  • Ginga-Curcu-Cherry pills
  • Cosaminobiotics
  • WD40methol spray

Times they’re a-changin’. Education is changing, Commerce and buying are different. I’d rather embrace than worry about retail medicine – at least it’s still face-to-face medicine, practiced by trained experts and patients in need.

What worries me is telemedicine and the notion that internet care is the next best delivery model for the masses, when its only as good as phone medicine, which is one notch better than wiki-medicine or google searches. There’s something wrong when the needful need not leave their home to get care or relief. Such E-consults will soon feature computer-generated holograms of Sir William Osler questioning, diagnosing and prognosticating. Don’t like his diagnosis? Then hit double-down 2nd opinion button and wham – you have another opinion from Dr. Zhivago.

I’m all for advances, but let’s not get ridiculous.

 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject
Dr. Cush is the Director of Clinical Rheumatology at the Baylor Research Institute and a Professor of Medicine and Rheumatology at Baylor University Medical Center in Dallas, TX. He a Professor of Clinical Medicine at the University of Texas Southwestern Medical School.
 
Dr. Cush is the Executive Editor of RheumNow.com and also Co-Edits the online textbook RheumaKnowledgy.com. 
 
Dr. Cush's research and interests include novel drug development, rheumatoid arthritis, spondyloarthritis, drug safety, pregnancy and Still's disease/autoinflammatory syndromes. He has published over 140 articles and 2 books in rheumatology.
He can be followed on twitter: @RheumNow.

Add new comment