bnapolitano, Author at Journal of Urgent Care Medicine

Recognizing the Difference Between Burnout and Moral Injury Can Help Save Your Staff

Physicians may be quick to admit certain symptoms of burnout—stress, decreased productivity, diminishing compassion—but are loath to consider they’re actually burned out. Call it denial or professional pride, but in truth they might be correct. That doesn’t mean there isn’t a problem that needs to be addressed immediately, however; a recent post on the healthcare website Stat notes an increase in “moral injury,” which is often misidentified as burnout. It’s actually akin to post-traumatic stress …

WSJ Calls Out Hospitals for ‘Secret Deals” that Hinder Competition (eg, from Urgent Care)

No less than the Wall Street Journal has claimed that “secret deals” hospitals strike with health insurers contribute in a big way to runaway health spending in the United States. In Behind Your Rising Health-Care Bills: Secret Hospital Deals That Squelch Competition, the Journal describes “secret restrictions” such as “anti-steering clauses that prevent insurers from steering patients to less-expensive or higher-quality healthcare providers.” (Certainly urgent care would fall into one, if not both, of those …

Don’t Let Cultural Insensitivity Cost Your Urgent Care Center Patients (or Bad Press)

A Maryland urgent care center is feeling the sting of negative news coverage, not to mention possible loss of patients and its reputation, after a woman says her daughter was denied care because of her race—by staff members who say they thought they were following company policy. The white mother brought her adopted black daughter in to the clinic after the girl jammed her finger. Based on the racial difference, the person at the front …

Syphilis in the Urgent Care Center

Urgent message: Seeking information beyond the stated history can prompt important information that informs the true diagnosis. This is especially true in patients with a complicated or potentially embarrassing history. Case Presentation A 59-year-old female with a past medical history of type 2 diabetes and hypertension presents to an urgent care facility with complaints of abdominal pain. She is well known to the urgent care staff. She is consistently noncompliant with medical care. Her hypertension …

A 16-Year-Old with Severe Pain and Immobility After a Basketball Mishap

Case The patient is a high school athlete who is brought to your urgent care center with severe pain in the area of his right foot and ankle. He reports that he jumped for a rebound, landing hard on another player’s foot with his full weight on his right foot. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page. Figure …

Abstracts In Urgent Care – October 2018

New Data Show ‘Steep and Sustained’ Increase in STD Occurrence—Especially Syphilis Key point: Over the past 5 years, rates of syphilis, gonorrhea, and chlamydia have all increased in the United States, with syphilis cases almost doubling and cases of antibiotic-reistant gonorrhea rising. Citation: Centers for Disease Control and Prevention. 2018 STD Prevention Conference. New CDC Analysis Shows Steep and Sustained Increases in STDs. August 28, 2018. Available at: https://www.cdc.gov/nchhstp/newsroom/2018/2018-std-prevention-conference.html#Graphics. Accessed September 7, 2018. Every other …

A 62-Year-Old Woman with Palpitations

Case The patient is a 62-year-old woman who presents to your urgent care center with a feeling of palpitations, which began the previous evening. She has no chest pain or shortness of breath, but does feel “clammy.” She takes no medications. Her history includes MI and CABG 5 years ago. Upon exam, you find: General: Alert and oriented X 3, skin color good but clammy Lungs: CTAB Cardiovascular: Tachycardic and regular without murmur, …

A 32-Year-Old Male with Unsteady Gait

Urgent message: Early diagnosis and management of multiple sclerosis are crucial for long-term prognosis. Urgent care providers must be vigilant with proper history taking and thorough physical examination when looking for signs and symptoms of early MS. Waqas Memon, MD, Zonaira Shabbir, OMS IV, and Muhammad Akhtar, MD, FACP Introduction In the early course of multiple sclerosis (MS), the initial symptoms are nonspecific and intermittent, which makes the diagnosis challenging.1 Focusing on common symptoms and …

Taking a QI Approach to Antibiotic Stewardship

In my previous column, I introduced why antibiotic stewardship is important to urgent care practice and presented some practical solutions to common scenarios that can lead to overprescribing of antibiotics. This month, let’s look at some efforts underway to promote stewardship through education and performance improvement initiatives. Quality improvement (QI) programs have several key components that apply very well to antibiotic stewardship initiatives; these can serve as a guide as you prepare your own plan …

A 72-Year-Old Man with Black Skin Lesions

Case A 72-year-old man brought his wife into the urgent care center because she woke up with a raw throat and fever. However, he also asks to see a clinician to ask about multiple black skin lesions on his cheeks and eyelids. Once in the exam room, he notes that he spent more than 40 years in the landscaping business, getting considerable sun exposure. He knows that put him at risk for skin cancer. In …