The insta-doc is IN | Bleader

The insta-doc is IN

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When it's not an emergency but you need medical help and your doctor can't see you for two weeks, who ya gonna call? A freestanding "convenience clinic," AKA McClinic, something Wal-Mart will soon be getting heavily into -- a walk-in place where you can be seen by a nurse-practitioner and get a prescription if needed.

Jonathan Gardner at Health Affairs links to a lot of debate over these things. I don't debate, I use them, but it's interesting to see what people have to say -- especially Clayton Christensen, who gives an in-depth interview in the actual magazine Health Affairs (free online until May 22).

Christensen's a BYU product now ensconced at Harvard Business School. He has an abiding interest in "disruptive innovation," a special case of what Joseph Schumpeter called "creative destruction" -- something capitalism's got that no other economic arrangement in human history has ever had.

The personal computer is a disruptive innovation -- compared to the mainframe, it's incredibly cheap and easy for a nonexpert to use. "When I was first out of school," says Christensen, "if I needed a computer, I had to take my punch cards to the corporate mainframe center and give them to an expert there who ran the job for me. Because computing was so expensive and required so much skill, we just didn't compute very often." The disruption in this case was the encoding of that expertise into personal computers -- but, of course, for most of us it has been anything but a disruption.

Christensen, a diabetic, has benefited from the same kind of thing in managing his chronic disease: first handheld personal blood-glucose meters, then mail-order blood tests and urine tests that make sure his daily management is sustainable long-term. "And so I actually have no need ever to see a physician.... With a chronic disease, so much of the information that's required to provide care actually arises on a day-to-day and hour-to-hour basis in the life of the patient."

McClinics are an institutional version of this process, since most of the medical care most people need most of the time doesn't require a physician's expertise any more than running a spreadsheet requires a PhD in computer science. Having knowledge partly automated and partly distributed to nurses or (as in the diabetes case) patients themselves isn't the same thing as providing top-of-the-line conventional medical care for everyone. But it may work better in the long run, thinks Christensen: "You can either try to replicate the costly system for the people who do not have access to it and somehow find a way to pay for it, or you can say, Let me just create a very different system. And in other industries, the second answer historically has provided higher quality and greater access with lower cost to more people."

Make no mistake -- this is also about "de-skilling." Here's a doctor with that kind of misgiving about McClinics. But aren't we better off with PCs than we would've been with a federal program for accessibility to mainframes?

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