[Roundtable Discussion with Four Practicing Doctors Using Their Real Names] Part 2: The Dangers of “Prescription Services” and the Challenges Facing “Convenience Store Clinics”
Patients Who “Just Want Medication” and Clinics That “Just Dispense Medication”… A Good Doctor Doesn’t Simply Give In to Patient Requests
So-called “convenience store clinics,” which emphasize convenience, are gaining prominence. Opening inside train stations and shopping malls and incorporating online consultations, they are steadily increasing in number by skillfully catering to the needs of busy modern people.
However, while they offer the benefit of “being able to see a doctor anytime,” drawbacks such as “frequent changes in doctors” and “missed diagnoses” have also been pointed out.Four practicing doctors on the front lines of healthcare—Dr. Tetsuya Kubota (pediatrics), Dr. Yoshimasa Goto (internal medicine), Dr. Kina Takagi (psychiatry), and Dr. Kazutoshi Kameda (orthopedics)—shared their candid views on the current state and challenges of convenience store clinics.
Not Medical Care, but a “Prescription Service”
Takagi: I once had a patient referred to me who hadn’t had a blood test in years, and when we ran the tests, it turned out they had lithium poisoning. Since even small amounts can cause poisoning due to dehydration or impaired kidney function, it is standard practice to monitor blood levels and adjust the dosage accordingly when using lithium carbonate as a mood stabilizer.Some psychiatric medications can cause kidney or liver dysfunction, or lead to side effects such as diabetes or dyslipidemia. Not just with lithium, but prescribing medication indiscriminately without blood tests is extremely dangerous. Convenience store clinics carry a high risk of this happening.
Goto: That might not be a problem limited to psychiatry. Whether in pediatrics, internal medicine, or orthopedics, I feel like the trend of “skipping tests” and “just prescribing medication” is gradually spreading. After all, patients themselves often clearly state, “I just want the medication.”
Kameda: Perhaps this is happening because an increasing number of patients view a “good doctor” as one who simply fulfills their requests. But medical care cannot be based solely on patients’ wishes.
Takagi: Exactly. A doctor must first diagnose the illness, perform tests if necessary, and rule out the possibility of other diseases before prescribing medication. If that order is reversed, it ceases to be “medical care” and becomes merely a “prescription service.”
Goto: That ad for “prescribing sleeping pills via smartphone alone” caused quite a stir on social media, didn’t it?
Takagi: That’s extremely dangerous. Sleeping pills and anti-anxiety medications aren’t the kind of drugs you can just take whenever you can’t sleep. Benzodiazepines, in particular, are addictive and shouldn’t be prescribed lightly.
Goto: If prescriptions are continued indiscriminately, the medication may stop working, leading to an increase in dosage. For the elderly, this can lead to problems such as falls and impaired cognitive function. If the cause of insomnia is sleep apnea, sleeping pills won’t solve the problem.
Kubota: Actually, a similar pattern can be seen with out-of-pocket treatments like Manjaro. There are dermatology clinics prescribing Manjaro on an out-of-pocket basis, which I find hard to understand.Manjaro is a GLP-1 receptor agonist, and it has serious side effects to watch out for—not just vomiting, but also acute pancreatitis and gallbladder disorders.
The other day, this came up in conversation with some doctor friends of mine: there are clinics where a counselor explains the treatment online, and then a doctor appears for just a few minutes at the end to prescribe the medication. Many of the doctors working there are part-timers, and they’re reportedly instructed to simply say, “Yes, that’s fine.” The conversation revolved around how it’s a race against the clock, and profits depend on how many patients they can prescribe to in a single day.
The Reality of “Not Being Able to Survive”
Takagi: Patients aren’t at fault—they’re just using the service because it’s available. The same goes for the nighttime house call service. This system, which allowed patients to be examined by a doctor at home without having to go to the hospital, was extremely convenient, but…
Goto: As demand grew, so did the number of cases where people requested house calls simply because “it’s a hassle to go to the hospital” or “I can’t take time off work.”
Kubota: “Originally, nighttime house calls were intended for patients requiring emergency care. However, when convenience takes precedence, the service ends up being used in ways that deviate from its original purpose.”
Goto: The more conscientiously a medical institution operates, the harder it is for them. Medical reimbursement rates are uniform nationwide. If you spend time examining each patient, perform the necessary blood tests, and provide careful lifestyle guidance, it becomes difficult to see a high volume of patients. That means losing out on profit.
Kubota: That’s exactly right. From a business perspective, it’s easier to make ends meet by finishing consultations quickly—like at a “convenience store clinic”—carefully billing for every additional fee allowed under the system, and seeing as many patients as possible. Medical reimbursement rates in Japan are low compared to the rest of the world. Yet labor costs are rising. The cost of medical supplies is also rising.Utility bills and rent are rising, too. Yet medical reimbursement rates aren’t increasing significantly. The reality is that we can’t survive unless we make the most of the system to maximize profits.
Goto: Patients seeking convenient medical care. Local clinics struggling financially. A healthcare system constrained by medical reimbursement rates. Perhaps “convenience store clinics” emerged as a result of the complex interplay between these three factors.
Kameda: I understand that the value of being able to see a doctor even on weekends, holidays, or at night is significant for patients.However, we cannot turn a blind eye to safety concerns and health risks. In that case, isn’t the only option to use these services selectively? For example, patients with chronic pain whose condition is stable, patients with conditions like gout who are on a stable medication regimen, or patients continuing rehabilitation can use convenience store clinics or online consultations to get prescriptions.
Kubota: Even in urology, there are cases where we can handle patients via online consultations if their symptoms are stable.
Goto: Depending on the patient’s situation, we always schedule regular in-person visits and perform blood tests once every six months. If necessary, we conduct imaging tests to directly monitor changes in their condition. I believe it’s important not to rely solely on online consultations but to combine them with in-person visits.
Takagi: In psychiatry, in-person consultations are definitely preferable. In urban areas, there’s an increasing number of clinics offering online consultations for patients with relatively mild symptoms; however, hospitals that admit patients requiring involuntary hospitalization, medical protection hospitalization, emergency psychiatric care, or those at high risk of self-harm or harm to others are facing a severe shortage of physicians.
Kubota: Young doctors want to work in a cost-effective manner. They tend to flock to medical institutions that offer high hourly wages—such as 15,000 or 20,000 yen—and allow them to leave on time.
Blaming “convenience store clinics” won’t solve the problem. The medical reimbursement system, regional healthcare, the shortage of personnel, and patients’ healthcare-seeking behavior—all of these factors are interrelated. However, I believe that what we, as private practitioners, can do is safeguard essential medical care. Convenience and safety. Efficiency and quality of care. Achieving a balance between these two is, I believe, the most critical challenge facing Japan’s healthcare system moving forward.
From the August 21 & 28, 2026, combined issue of *FRIDAY*