番茄社区

Getting a flu shot recently turned into a 2-hour ordeal for me.

It started at a CVS MinuteClinic at 9:30 a.m. on a Saturday. The clinic was staffed by a nurse practitioner -- at least that's what she said she was. She wasn't wearing a name tag and there was no certificate on the wall identifying her. Nor was there any other sign around identifying who this practitioner was.

I guess I just needed to trust Corporate America to be truthful about her credentials.

I knew there would be trouble about 15 minutes into the visit. I filled out demographic information on a touchscreen computer outside the exam room, which turned out to be a windowless cubicle about 10-by-10 feet at the back of the pharmacy. The clinic sign said it was associated with the University of Texas Health Science Center at San Antonio.

For about 25 minutes I could hear sounds of a child with a croupy cough coming from the exam room. There was another patient waiting ahead of me.

When the mother and child came out, the guy ahead of me in line went in for what he told me was a flu shot. The computer monitor said his visit would take 8 minutes.

Twenty minutes later, he still wasn't out.

When I filled out the computer information, I answered all sorts of questions about medical history and allergies (eggs, vaccines, medications) and signed all sorts of waivers and releases.

Then the other guy emerged, and it was my turn.

The NP immediately apologized and said she was having computer problems.

She called a "manager" to complain that the last patient's information wasn't being handled properly.

So, responding to questions from the manager, she pulled up pictures of scanned copies of the patient's driver's license and insurance ID cards, larger-than-life, on the screen. So much for HIPAA privacy concerns.

To be fair to her, she did ask me to sit down, and I would not have seen the screen had I done so. But I wanted to have as little contact with the contaminated surfaces of that exam room, as I could see a long, extended illness in the offing from "pedi-crud" from the kid who coughed all over the room before I went in. I could see that the NP had not cleaned the room at all after his visit.

So she started by trying to see the information I had entered into the database.

She quickly reported there was none, and she would have to start all over again.

I gave her my driver's license and two insurance cards to scan and then manually enter into the computer.

The data would not populate. She tried at least three times but couldn't get anything to enter.

She gave up and said I would have to come back later.

I asked her who her supervising MD was at the UT HSCSA. She said she didn't know.

By now it was 10:35.

I asked her to remove all the demographic information from the computer. She said she would.

I drove to a grocery store pharmacy down the road.

I filled out a one-page paper form. The pharmacist and a very nice pharmacy student from UT Austin who was shadowing her gave me the shot. The whole thing took about 20 minutes.

A few observations:

1. The CVS MinuteClinic business model appears to be in trouble.
2. It has severe IT problems.
3. It doesn't take a NP to give flu shots.
4. It doesn't take an electronic medical record to give flu shots.
5. There appears to be little, if any, supervision of the MinuteClinic NPs by the UT system.
6. If this were a heart attack patient coming in with symptoms masquerading as "the flu," the NP would be so busy fooling around with the computer that she wouldn't recognize the potentially fatal acute condition until it was too late.
7. It's important to focus on the patient first, and not on the computer or the business model.
8. I wonder if and when the business gurus managing this clinic will figure out that it is taking way longer than 8 minutes to administer flu shots.

This kind of impersonal care is typical of what is in store for Americans as MBAs and bean counters totally control our healthcare system and look at "metrics" to guarantee access. I got access all right. But did I get quality?

Doctors and NPs and PAs are just assembly line workers. Patients are just widgets on the assembly line.

As I have said before, patients are either cost centers or profit centers. Today at CVS I was a cost center. And I didn't buy any kitchen or bathroom supplies in my trek to and from the back of the store.

So the business model wasn't realized.

It's all about marketing. It's a MinuteClinic. You keep thinking that.

Even though for me that morning it was a Too Many Minutes Clinic.

Editor's Note:

番茄社区 reached out to CVS for a response, which is below.

Statement From MinuteClinic

MinuteClinic, the retail medical clinic of CVS Health, has provided high quality, accessible, patient-centered care for more than 22 million patient visits nationally with a 95% customer satisfaction rating. Our board-certified nurse practitioners and physician assistants follow evidence-based clinical practice guidelines to diagnose and treat common family illnesses, provide vaccinations, and administer prevention and wellness services. We have received three consecutive accreditations from The Joint Commission, the national evaluation and certifying agency for nearly 20,000 healthcare organizations and programs in the U.S.

We are looking into the experience surrounding Dr. Mittler's visit and will address any related issues as needed.

, has been a cardiologist in private practice in San Antonio for the past 38 years and has an active litigation practice in healthcare law.

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