I just had my first encounter with the US medical system outside of university. The place was part of the Beth Israel Medical Group, called Docs Physicians, and I went as a walk-in to the branch at 55 E 34th. They opened at 9am on saturday morning, so I arrived a bit early and had a coffee and bagel next door before I went in. There were two patients before me, and the wait was short (30 min) even though there was only one attending physician. I told the doctor that the last time I had suffered a prolonged cough from a cold, I had been prescribed an inhaler, and may have accelerated the diagnosis a bit that way. Docter was Keith Uleis, he ended up prescribing an antibiotic (Azithromycin), an inhaler (Albuterol) and a steroid (Prednisone) for inflammation control, after putting me on a nebulizer for 15 min to gauge the possible asthmatic effects. The charge for the consultation was $225, and filling my prescription next door at Pasteur Pharmacy cost $10 (steroid) + $40 (antibiotic) + $50 (inhaler) = $100.
I can’t believe it took me this long to figure out that I needed to go to urgent care – am seriously wondering about the purpose of having a primary care physician, which I spent part of yesterday trying to pick out. The differences: one, familiarity with medical history; two, a more relationship-based, as opposed to transaction-based, incentive system; three, most importantly, scheduling flexibility.
Giving doctors uniform access to standardized medical records gets rid of the first point. As for the second, I dislike decision by anecdotal evidence, which is what the relationship model encourages. What I want is for my accessible doctor pool to be more effectively commoditized, by virture of some standard success record. Urgent care centers may provide that by acruing reputation as a collective and not on a doctor basis.