The phrase is used to mitigate concerns that more serious problems will be treated in the bare bones environment of a few hundred square feet partitioned off from the men’s underwear and staffed by a lone mid-level provider (MLP).

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I will admit something. I have thirty years of experience as a board certified family practitioner. I’ve had more than 250,000 patient encounters. I would be frightened to death to work next to the men’s underwear. It’s a job best described as a disaster waiting to happen.

The reality is this: one of medicine’s most difficult diagnoses is recognizing when a problem appears to be simple but is actually much more serious.

Chances are, if a patient walks through the door sweating, clutching his chest, ashen, and complaining of chest pain, even the clerk selling the men’s underwear could recognize a heart attack. That’s not a simple problem. But it’s an easy problem to diagnose. Sometimes the serious, complicated problems are the easiest to recognize.

But what about a patient who presents with a minor shoulder injury. The injury is described as “just a little ache,” one that gets worse when the patient plays catch with his son. Simple shoulder strain. Simple problem. Right?

What if the exercise that makes the pain worse is not actually playing catch but the brisk walk to the park? What if the shoulder pain is unaffected by throwing a baseball? What if the patient has significantly elevated cholesterol but never looked at the results of his blood work from his church’s health fair? And what if the shoulder pain is actually atypical angina and indicative of a left main coronary artery about to become completely occluded?

That’s not a simple problem. Will a protocol discern that it’s not? Does the retail clinic have the means of doing an EKG? Even if the MLP has enough clinical experience to pick up on this subtle presentation, can she initiate a workup?

And what about that iconic “simple sore throat.” In 1990, Jim Henson, the creator of the Muppets, had a sore throat. He popped into a clinic and saw a doctor who diagnosed a “flu-like illness.” 36 hours later he was dead. Kermit the Frog’s Dad died from a sore throat.

The care in a retail clinic is devoid of all the factors that define high quality medical care: continuity, follow-up, diagnostic sophistication, access to medical records, and effective backup. I would feel utterly exposed sitting in that room next to the men’s underwear for a 10 hour shift.

The tragic truth is that for many, it is the only health care available. How can it be criticized?

Consider this quote from Web Golinkin, the CEO of RediClinic, the company running Walmart’s retail clinics, “When you put the convenience together with the affordability, and then you match that with high-quality routine health care, that's why this is such an appealing concept that I think will grow very rapidly.”             That quote should make anyone who cares about the quality of American health care shudder because while I would like to believe that Mister Golinkin knows what “high-quality ...health care” is, while I would like to believe that he understands that the routine is not always routine—I don’t.              Do you?

Dr. Jeff Wagonner

About the Author

J.R. Waggoner, M.D. practiced family medicine for thirty years in Aurora, Colorado. He also worked as a consultant and herded cats as the managing general partner of a general partnership of physicians. Three years ago, he left his practice to study health care policy and write. During his time away from clinical work, he has written two books and worked as a Senior Clinical Content Specialist and freelance writer.

His current book Medical Metamorphosis: The three step cure for America's health care crisis is available at Lulu.com.