I can’t stop thinking about a drive-thru. Not the one for burgers and shakes but the one for ear checks, sports forms, quick med refill visits or a lingering rash. For those things you just want to know fast or need done now, but don’t want to spend 2 hours resolving. For those things that really make you worry as a parent. Instead of the millisecond-mall-type clinic, we all want our doctors, our clinics, and our child’s team to provide health care. In my opinion, parents and pediatricians both believe in the medical home.
Imagine if you knew your doctor did the drive-thru on Tuesday afternoons. Would you swing by to ask about that rash you’re worried about or to check in on your child’s ears? Follow up on a new seizure medication? What if it didn’t even require a call ahead of time? What if tight time restraints were agreed upon (say 7 minute visits or so) in advance so the patient/physician agenda was aligned? Swing by on your way to daycare?
We want quality, trust, and mobility when it comes to health care. We want easy access, too. Of course we must fight for improved electronic visits and online advice. We want comprehensive, compassionate preventative care. We will need in-office visits, yes. And sometimes we need hands-on more urgent care, too. Now the “kwik-clinic” idea isn’t new, I know. Even hospitals are opening urgent-care clinics throughout the country. But your pediatrician often isn’t involved. So what about that drive-thru:
This all started for me when a pediatrician friend spilled her dream list for a new pediatric clinic. In it she mentioned the “ear-check drive thru.” She said, “Sometimes parents just want to know if they can let their child cry at night–or if it’s an ear [infection] keeping them up.” The drive-thru concept became a reality when her clinic recently had to evacuate for a mechanical issue in the building. They cancelled all the afternoon visits but she was on-call and spent the afternoon seeing patients out of a station wagon. She said it was phenomenal. It was efficient, centered around the patient, and more directed than usual. Less waiting, less exposure to illness for children in the waiting room, and easy for parents. Imagine being able to pull up in line, chat with the doctor and have an evaluation without unbuckling the car seat.
Would adolescents feel more comfortable asking questions from their car? Would they swing through for a medication check or to chat about a new embarrassing problem? Does the environment of the car improve the ease for asking questions for some?
Mobile health in an entirely different way.
I recognize the complexities, limitations, and difficulties with providing medical care in a parking lot of course. Some patients would need to be triaged inside to the clinic. But I also sense great opportunity for service and patient-centeredness, cost reduction and partnership.
I’ll write next about the other kind of mobile health and exciting new data that compels us not only to build the drive-thru, but also to use mobile apps to promote patient’s health (there’s already an app for ear checks). We live in a time where no longer is it the patient’s responsibility to conform to the system; I believe we live in the time where physicians must innovate to meet the needs of patients.
Tell me, would you use the drive thru to go see your pediatrician? Give me some details, please. Maybe we can make this happen. Below I’ve included some preliminary responses I got on Twitter. Please share yours, too.
As to the second-to-last tweet, for those under 24mo with a certain diagnosis, it is entirely appropriate to treat with antibiotics, right?! I always feel defensive when my kids are on antibiotics for ear infections (we are past them now, 20mo with tubes and 38mo), and people act like the Rx isn’t necessary and I’m recklessly and unnecessarily contributing to antibiotic resistance in the country. I get it if there is just fluid/no obvious infection, watchful waiting for over 6mo. But a legit ear infection in an <2y/o should be treated with antibiotics, right? It is not like I'm a crazy mom of a toddler with a cold, demanding an Rx. And when I was pregnant, I got the only double ear infection I remember in my life and it was AWFUL!! like crying on the couch because I couldn't eat and the heating pad couldn't cover both ears at once, awful. Amoxicillin substantially reduced the pain in 24ish hours. SO even in the over 24mo demographics, if they are in that much pain, how could you not give them drugs that would likely make them better?
Wendy Sue Swanson, MD, MBE says
Yes, Laura. There are certainly times for antibiotics and the guidelines often do recommend antibiotics under age 24 months.
Here’s a blog post about some of the research (and controversy!)
Thanks!! That was really helpful. And reading that article made me think again and even more, ohmylord, we need drive through ear checks! I’m just having stressful flashbacks of post-antibiotics follow ups with fluid or redness seen in the ear, that prompted a second follow up 48-72hrs later to see if it progressed, that (if it did) prompted another follow up to see if that Rx worked. So much time sitting in traffic, sitting in waiting rooms, sitting in office visits, missing work, missing dinner, missing sleep. (the whole time losing track of where you were on the track to tubes)
Wendy Sue Swanson, MD, MBE says
Thanks, Laura. Over time, apps like Cell Scope will help w this too. You’ll hopefully be able to do this from home! Imagine taking a picture w cell scope and sending it to your pediatrician for review at the 48 hr mark to help you determine next steps. Would be so helpful and SO much more efficient and kind to all involved.
This would be an amazing option! I’m blessed with an amazingly healthy kiddo, but my questions/concerns typically are in follow up to well-baby checks. Questions that aren’t always worth the effort it takes to get through the switch board of the office to my actual pediatrician, or aren’t worth risking my child’s exposure to the coughing kiddos in the waiting room, but that I’d still like the comfort of reassurance on from my pediatrician (and not, say, Dr. Google or non-ped physicians in my extended family).
Gayle Smith, MD says
Fast, Good, and Cheap. That’s the triad for most things, and this I know for sure: you can only have two of the three in any given situation. If the drive-thru doctor visit is truly going to be fast and good…it won’t be cheap. McDonald’s is fast and cheap…but it isn’t good (or particularly good for you, but that’s a different issue altogether!)
Fast, Good or Cheap. Doctor’s are all different in our style and approach to patient care. Which two of the three matter the most to parents? Different combinations at different times in our parenting journey, is the honest answer. Healthcare delivery that is flexible to fit the changing needs of parents and children may be the ultimate winner.
Wendy Sue Swanson, MD, MBE says
I agree that we want different parts of the health system at different times. Precisely why it would be OV1 type 99212/99213 type visits only that I imagine in the drive-thru. All else would demand more “traditional” care. But you may know FAR more about this—don’t you do home visits?
However, I don’t know if I buy that you can only have 2/3 of your equation. If incentives aligned, expectations aligned, why can’t we have fast (10 min visit) blended with good (high quality dr in the drive thru) and cheap (billed appropriately to insurance, etc)?
PICU MD says
I think the biggest barrier to “alternative” visits (i.e. evists, drive through visits) are our current billing and coding schemes. If Pediatricians could bill (at a reasonable rate) for visits that were not the normal face to face “sick” or “well” visits you would see more of these types of visits. Note that folks who practice concierge medicine often engage in these types of visits since they are not bound by our dysfucntional billing system.
Wendy Sue Swanson, MD, MBE says
I agree. Would love to accommodate care that makes sense (like this) but hate to think that families have to pay out of pocket for it like in the concierge model…We will get there– just need the payers to help lead the way
Allana Pinkerton says
This is an awesome idea! Wish I had it for my kids when they were younger.
It’s a great opportunity to make sure kids are in a car seat and the appropriate one. You can also discuss extended rear facing. Check out how to become a certified Child Passenger Safety Technician at https://cert.safekids.org
Locally, Diono will be hosting certification classes next year at our Puyallup headquarters. Keep up with us on our Facebook page or Twitter or contact me directly at firstname.lastname@example.org
As their Child Passenger Safety Advocate, I am here to help!
Frances Gough, M.D. says
My company is testing parts of this model of healthcare delivery via phone and webcam. We hope to fill the gaps when going to your regular doc isn’t feasible or convenient – as Dr. Swanson says, for those things you just want to know fast or need done now, but don’t want to spend 2 hours resolving.
I believe that for the most part, with the right infrastructure, training and quality control we can accomplish good (quality care), fast (appointments within 15 minutes of someone requesting care) AND inexpensive (affordable for most families and much less expensive than an ER visit) care that addresses most common medical conditions. Since 2010 we’ve been using a mix of phone, webcam and in-home visits to help large employers like Microsoft, Costco and Franciscan Health System reduce health care costs.
With cutbacks in benefits at many companies it is concerning that patients might not seek out the care they really need. So we are now making these services available for the first time to individuals and families in Washington and California. We are in intensive beta testing mode right now, because we want people to have great experiences that give them peace of mind.
If anyone here would be interested in trying it out, I would be grateful for the feedback as we roll it out at http://www.CareSimple.com. Introductory pricing is $10 per visit, but we are also looking at a long-term monthly membership model. Please feel free to email me at Frances.Gough (at) CarenaMD.com with feedback or questions, and I’m also happy to answer any questions or address concerns here.
Frances Gough, M.D.
Chief Medical Officer, Carena
Sarah - summitmedicalcasper.com says
Great idea. But I think, proper examination is needed and this idea is only applicable to light service which suit more to nurses service rather than a doctor.