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• Talk about where you get your health care in the Cold and Flu Exchange

The delivery of medicine has rapidly changed. In the past, people would establish themselves with a general practitioner (primary care provider) in their community and stick with them for a long, long time. Because people rarely stay in the same place very long anymore, change jobs, and change insurance coverage, many people are now relying on free-standing medical clinics, popping up in pharmacies, big box stores, and strip malls everywhere. I had the distinct pleasure of working in one of these so-called " Doc in the Boxes " nearly thirty years ago, when they first made their debut. It really seemed strange to deliver medical care in a shopping center, located between a grocery store and video rental place, but not any more. The U.S. now has thousands of them, with more opening every day. When someone tells me that they do not have access to medical care, they may not be aware of one of these facilities in their own town. An OB-GYN rented a store front in a large shopping center. If he was running late (always in this field), he gave the patient a beeper, like the one's used while waiting for a table in a busy restaurant. They could go shopping, have a snack, and nurse or receptionist would beep the patient ten minutes before they were ready for them. His patients rarely complained about waiting anymore. My own large medical group recently decided to jump on the rapidly expanding medical bandwagon and open a half dozen or so quicky-care facilities (not their real name) a few years ago. Staffed by nurse practitioners in a little kiosk, these little clinics are tucked away in the corner of a large chain pharmacy. They are not my idea of a great practice, but some patients seem to love them. They can get stuff for dinner, buy motor oil, get some digital pictures made, buy a frame, get a flu shot, and get treated for pink eye (and fill the prescription, of course) all in one stop. Many years ago, the former Soviet Union demonstrated a unique, conveyor belt cataract clinic. Several people at a time where placed on beds that rotated around this huge turntable; all set for different stations. The first station prepped the patient, the second set up the surgical trays, the third put them under anesthesia, the fourth station performed the surgery, the fifth woke 'em up, and the sixth one wheeled them away to recovery area, the seventh station cleaned up the mess, and the eighth station plopped another patient in the bed. Next! People clearly do not like waiting. We have fast food, drive-through coffee, and ice cream, so why not fast medicine? A family practice doctor in Kentucky charged by ten-minute increments. Whatever a patient can cram into ten minutes or twenty minutes was fine with him. The patient decided on how many increments of time they would need for their visit. I was pondering about how quickly PETs (pressure equalization tubes) are inserted in ambulatory surgery centers. Most ENTs can insert a set of ear tubes in a quickly-anesthetized child in about ten minutes flat. These simple procedures - probably the most common surgical procedure done on children in the U.S. - cost a few thousand dollars. Man, that is a lot of dough for ten minutes of work and a few dollars (should be pennies) of material. Granted, there are liability insurance costs, the cost of the anesthetist, and use of the surgery center, but there is still a wide profit margin here. It would not surprise me to see some ENT entrepreneur setting up his own "Jiffy Tube" franchise someday. Where will it end? I have seen ads for In-and-Out hemorrhoid clinics, laser skin clinics, mammogram vans (Mammo-vans or a better name, Jiffy Boobs), and other mobile health clinics. My PA wife worked in a Clinic on Wheels (affectionately termed the COW, complete with a cow logo on the side) doing well-child examinations and vaccinations for new immigrants, at their apartment complexes, churches, and other neighborhood gathering places. I suggested one of the horns that moo, so the people would know that the van had arrived. For some reason, they did not latch on to the idea. Doctors are now consulting on cases over the Internet, linked directly by live-feed video to other doctors all over the world. UC Davis School of Medicine launched on the first Robo-Docs years ago - a robotic machine to assist in hip replacements. Since then, other doctors have actually performed remote surgeries on patients thousands of miles away, using robotically-assisted instruments and video laproscopy. The technology is here and current used in many rural health clinics, were a person can hold a video otoscope up to the ears of a patient, and the medical provider can make the diagnosis from hundreds of miles away. Not all Navy ships at sea can have the medical specialists on board, so telemetry and video medicine is commonplace now. People are getting prescriptions for Viagra and other meds for erectile dysfunction over the Internet , by a "licensed, U.S. physician" who will ask you some brief questions. No examination, of course, and it is legal. I heard a rumor that our local radiological group owns a villa in Italy. It can be used by any of the radiologists, who can still read digital films over the Internet in a different time zone, while his colleagues in the U.S. are sleeping. As you may or may not know, some health organizations outsource the reading of digital films to radiologists in other countries, like India. They do this to save money, of course. In a heavily-accented voice, you may hear, " My name is Jeff and I will read your MRI... " When our kids were in high school, we were coerced into doing sports physicals at the schools. We could do them so quickly and efficiently, that the word quickly spread to other schools and coaches. When he finally put the halt on it, we ended up doing 2,000 sports physicals per year. We did this for seven years on Saturdays, days-off, and some evenings. I still have a bit of carpal finger syndrome from doing all of those turn-your-head-and cough hernia checks. Along the line of the Good Humor Man, perhaps we can have a Good Health Man? He can drive around the neighborhood playing his Turkey in the Straw music, until someone hobbles out on crutches, or clutching a bloody finger, stops him for instant medical care. It could work. The medical provider could even sell ice cream (low-fat, of course), and encourage exercise by having people run for the van! Are we going to see a "Jiffy Pap" or "Pap-o-Mat"? Probably not, because I can't see women, on their lunch hour, trying to get their annual exam by walking over and straddling a pit. How about a colon clinic for those interested in quick colonoscopy ? Soon, with virtual colonoscopies , you may be able to just swallow a camera and download (so to speak) your colon video to a web site. The proctologist and the ENT can team up and call it "Rears and Ears"! Charles Schultz's character, Lucy, had the original idea years ago by having a booth - "Psychiatric Help Five Cents". I sure could use that right now. Comment on this post and talk with others about how and where you get your health care on the Cold and Flu Exchange.