Shortly after the Kaiser Permanente Care Corner clinic opened for the day in a southwest Bakersfield Wal-Mart one recent Friday, licensed vocational nurse Irene Ethridge decided to drum up some business.
"Hi there. Are you a Kaiser Permanente member?" she asked a woman strolling through the store's adjacent pharmacy.
"Yes," replied Kim Klaas warily.
Ethridge brightened and explained that as such, Klaas was eligible to use the telemedicine services at the clinic, a two-year pilot project of Kaiser -- which has about 102,000 members in Kern County -- and the nation's largest retailer.
The Bakersfield telemedicine clinic is one of two that Kaiser opened in October. The other one is in Palmdale.
Kaiser members and Wal-Mart employees can walk in, no appointment necessary, and have minor ailments assessed by a health care provider via a high-resolution webcam in a private room. A registered nurse in San Diego does an initial screening, followed by an urgent care doctor in Bakersfield.
The clinic is open from noon to 8 p.m. Thursdays through Mondays. About 125 people have had exams there so far.
Klaas, 39, was feeling well on Friday, but she was intrigued.
"I love the hours," said the mother of two children, ages 5 and 6. "Kids always seem to get sick at night when the doctor's office is closed, and a little ear ache isn't the kind of thing you want to go to a hospital for."
Retailers have been operating clinics inside stores for years, but until recently telemedicine has largely been confined to traditional clinical settings, usually for consultations between far apart medical colleagues.
Because it's efficient and convenient, telemedicine is likely to expand into all sorts of nontraditional settings, but there should be standards to ensure patients are getting good care, said Mike Harris, a principal with Harris Consulting, a Los Angeles-based healthcare consulting firm.
"Of course we have to make sure we closely monitor it to be certain we're not putting patients at risk," he said.
The exam at Kaiser's Wal-Mart clinic is much more than just talking to a computer screen, Kaiser notes.
With a specialized stethoscope placed on the patient by the nurse at the clinic, remote doctors can actually listen to the patient's breathing and heartbeat, just as they would in a face-to-face exam.
An otoscope with a camera on it also allows doctors to look deep into a patient's ears and eyes. Similarly, a special dermatoscope can transmit extremely detailed, magnified images of skin lesions.
Patients with sore throats open wide for yet another camera.
For routine ailments, doctors can transmit an electronic prescription that patients can fill immediately at Wal-Mart, or at another pharmacy if they choose to wait.
If the condition appears to warrant an in-person exam, patients are referred to Kaiser's urgent care clinic on Stockdale Highway, where they will likely see the same doctor who was on the other end of the webcam.
The partnership between Kaiser and Wal-Mart is part of an ongoing strategy Kaiser is pursuing to make health care generally more accessible. It's trying out a traditional clinic at Paramount Farms for employees of the agriculture company, and a mobile clinic that travels to outlying areas of the county six days a week. There's also a mobile phone app for making appointments and communicating with doctors.
"We want to take health care beyond the traditional setting to the places where people shop and work," said Kaiser chief administrative officer Sharon Peters.
If visiting the doctor is convenient, the thinking goes, patients will come in sooner and possibly avoid the health consequences and expense of more severe problems down the road.
Going to a doctor's office in the middle of the day isn't convenient for most people, but swinging through a clinic while shopping isn't too much trouble.
"This really fits in with the needs of our patients," said Kaiser medical director Dr. Julia Bae. "Millennials and the younger population, especially, don't value the traditional one-on-one office visit. They want care to fit into their busy schedules."
Wal-Mart says the experiment is one more way to better serve its customers.
"We are always testing new products and services to provide our customers with affordable ways to stay healthy," said spokeswoman Danit Marquardt. "This is an example of one of those pilot programs."
Customers who are not Kaiser members or Wal-Mart employees can't take advantage of the telemedicine exams, but they can use self-service options such as health research or checking their weight or blood pressure.
Linda Urias, 65, doesn't belong to Kaiser but stops in at the clinic whenever she's in the store picking up groceries.
On the recent Friday, she checked her blood pressure.
"A little low today, but at least it wasn't high," she said.
Urias also stepped on a scale to make sure her diet is still on track. She recently lost about 20 pounds, and is trying to keep it off.
"I've changed the whole way I eat," Urias said proudly.
It's those types of health conscious consumers retailers hope to appeal to with in-store clinics.
The partnership between Kaiser and Wal-Mart has a lot to offer both sides, said healthcare consultant MaryKate Scott of Hartland, Maine-based Scott & Co., which has had Wal-Mart as a client in the past.
The obvious benefit to Wal-Mart is the potential to sell prescription and over-the-counter medicine, but that's only part of the story, Scott said.
There are about 2,500 retail clinics in the United States. Stores like them because they generate foot traffic at a time when a growing number of consumers are shopping online.
"They want customers walking through the store with their shopping carts making impulse purchases," Scott said.
Plus, health care costs are a major concern for Wal-Mart as the employer of some 1.4 million employees. If it can keep those workers healthy, that's a huge savings, Scott said.
And if health care costs worry an enormously successful international retailer, how much more so for its customers, typically working-class people for whom insurance is a major expense.
"If I'm Wal-Mart, I'm thinking, 'Health care is a big deal for my customers. And if it's a big deal for my customers, it better be a big deal for me,'" Scott said.