Originally written on April 27, 2010

Just last night I was watching my local news and heard about how some local Wal-Marts are now offering in-store medical clinics for shoppers. These clinics–or convenient care clinics–are supposed to be a quick alternative to having to make an appointment with your Doctor and then waiting, who knows how long, to see your Doctor. I did a little research and found that this is not unique to Central Pennsylvania. Wal-Mart has already opened several of these clinics around the country, with 400 total, scheduled to be opened this year.

This phenomenon of quick health care in a large retail store is not unique to just Wal-Mart. Many large grocery store chains are doing the same thing. What is interesting about these clinics is that when one drops in to perhaps get a sore throat looked at, they are not seeing an M.D., but rather a CNP; Certified Nurse Practitioner. I have no problem with CNPs, in fact, the CNP I see on regular basis is more competent and knowledgeable in general medicine than just about any M.D. I’ve ever seen.  The problem is, a CNP is not bound by Hippocratic Oath, therefore they can refuse treatment to any patient that comes in.

These convenient care clinics are not operated directly by Wal-Mart either. There are four main companies that provide this service to retail outlets and they hire the majority of their nurses through temporary agencies. I won’t go into great detail about temp agencies–that would be a whole post in and of itself–but I will say that they pay well below median wages; offer little, and usually no benefits; force one to work long hours and give absolutely zero guarantee of having any job security whatsoever. This is particularly troubling in this case considering someone could walk in to one of these convenience clinics with a potentially serious medical problem, but could be easily misdiagnosed. Not because of any incompetency on the part of the Nurse, but because of the stress of the long hours and low pay: things can get easily over-looked. I doubt I am alone in the feeling that I want anyone treating me for a medical problem to be well-trained and well-compensated.

The proprietors of these clinics insist that they are for minor medical problems, not a serious emergency situation. But considering the number of uninsured citizens who are forced to use emergency rooms for any and all medical situations that arise, why wouldn’t they go to the Wal-Mart–the same place they use to buy cheap food and other items–for their medical services? Again, these clinics can refuse service to anyone. So someone hoping to get treatment at Wal-Mart could be turned away and forced to go to a hospital: losing valuable time in the case of something more serious than a cold or flu. They might just not bother going to the hospital at all if they believe it isn’t serious enough for emergency treatment , but could turn into something more serious if left untreated.

In a larger context, these clinics are a manifestation of some of the inherent problems and inequalities of the American healthcare system. I’m not sure as to the status of all of these Wal-Mart clinics, but the one’s in Central Pennsylvania do not accept medical assistance recipients, but only a few private health insurance providers. Perhaps the entire rationale for these clinics can be understood in one word: consumerism. In the news segment I watched, they showed that the patients–ie: consumers–were given a little beeper that would buzz when the nurse was ready to see them, just to make sure they can be shopping in the store while they are waiting. I can’t say I’m surprised in the least by Wal-Mart now contracting these clinics. When one goes into a modern Wal-Mart; one can go get their fast food, do their banking, get their hair cut, see the optometrist…so on and so forth.

I understand the convenience of having these services in one place, yet it is solely a means of driving more consumers to Wal-Mart to, well.., consume. They can rent out space to these other enterprises who use cheap, temporary labor. These other businesses know they will get a steady stream of traffic and Wal-Mart knows they will be enticed to shop there after they receive these services. It’s a win-win for profiteering and consumerism. But where does it stop? Wal-Mart’s monopoly on cheap goods has forced many other businesses to close since they can’t compete with the prices and/or convenience. What more can Wal-Mart possibly add to their stores? Probably a lot. How about attorneys, accountants, dentists? Why not a Wal-Mart charter school? Hell, why not Wal-Mart University. Go to class, buy some crap at Wal-Mart, go back to class, then go to your new job–at Wal-Mart. Perhaps Wal-Mart housing developments would be a good idea. You’re already working, shopping and getting all other goods and services from there, why not live there as well? It would be good for the environment as you wouldn’t have to drive anywhere. You can go visit grandma in isle 27 at the Wal-Mart nursing home.

Of course, I was being a little bit sarcastic toward the end there. Yet, there may be some rational concern as well. Consumerism literally consumes our lives; and Wal-Mart has a vast monopoly on the products and services we consume. But why fight it? I need to get to Wal-Mart as they are having a special on cat litter, underwear and prostate exams. See you there…..