The patient is a 64-year-old woman who presents with sudden onset, bilateral hip pain. She otherwise appears healthy, but reveals that she has a history of breast cancer. Examination reveals nothing remarkable. View the image taken (Figure 1) and consider.
Read MoreThe Case of a 42-year-old Fireman with Shoulder Pain: When a Lifeline Becomes a Noose
There are some diagnoses that will be missed by nine out of 10 physicians; this is one of them. However, our goal is not to meet “Standard of Care” but to provide excellence in care: Take every patient at face value, without trying to guess their intentions for secondary gain. Ensure you are aware of the chief complaint stated to the staff in the urgent care center. Be an open book in your impression and …
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Pitfalls in Assessing and Managing Common Pediatric Injuries
Urgent message: Fractures, in general, are relatively common among pediatric patients. Those most likely to be seen in the urgent care setting include injuries to the radius, ulna, humerus, lateral condyle, clavicle, tibia, and fibula. The second of two parts. Justin Kunes, MD, Shane R. Hanzlik, MD, Allison Gilmore, MD As noted in part 1 of this article (published in the February 2011 issue of JUCM and available at www.jucm.com), fractures are common injuries in …
Read MoreHealthcare Laws vs. Newton’s Laws
Lee A. Resnick, MD, FAAFP Newton’s Third Law: “To every action there is always an equal and opposite reaction.” Medicine applies Newton’s Third Law liberally, from physiology to pharmacology; negative feedback loops, down-regulation, compensatory states, and medication side effects all follow its principles. The body, as we well know, is inclined to homeostasis, and any upset to this balance is met with resistance and dysfunction. Unfortunately, well-meaning healthcare regulators, policymakers—and, yes, even fellow physicians—have ignored …
Read MoreECG Challenge: A 73-year-old Male with Concerns About His Pacemaker
Urgent message: Identifying the most likely cause of a 73-year-old male’s sensation that his heart is “missing beats” — while being mindful of the most potentially serious sources—will guide decisions on the right course of action. The ECG you order will offer invaluable clues as to the appropriate steps to take. By John F. O’Brien, MD The patient is a 73-year-old male who presents with a primary complaint that it occasionally feels as if his heart is “missing …
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February 2011
Developing Data: February, 2011
In each issue on this page, we report on research from or relevant to the emerging urgent care marketplace. This month, we continue looking into data brought to light in Many Emergency Department Visits Could Be Managed at Urgent Care Centers and Retail Clinics,1 an article that (as the title implies) compared the capabilities and usage of urgent care centers vs. other immediate-care options the U.S. It may be most valuable to the urgent care …
Read MoreAbstracts in Urgent Care: February, 2011
Most Frequently Missed Fractures in the Pediatric Emergency Department Key point: The most commonly missed fractures were pha- langes of the hand and metatarsal fractures. Citation: Mounts J, Clinenpeel J, McGuire E, et al. Most frequently missed fractures in the emergency department. Clin Pediatr (Phila). 2010 Dec 2. [Epub ahead of print.] This study quantified the types of extremity fractures most commonly missed on plain radiographs by pediatric emer- gency medicine specialists after an initial …
Read MoreSay ‘Arrivederci’ to Printed Materials
An interesting title for a book addressing the impact of the electronic information age might be The End of Paper. Look around. Daily newspapers are dramatically down in circulation and shutting down at a rapid rate. That 20-volume encyclopedia that used to sit on your parents bookshelf? No mas. Those written assignments at every school level? A thing of the past. Seems like a no brainer. Out with the paper and in with the electronic …
Read MoreLike Super Good Written, Verbal and Non-verbal Communication and Stuff
JOHN SHUFELDT, MD, JD, MBA, FACEP I will begin this short essay by admitting that I am not always the best or most appropriate in terms of my style or manner of communication, which is no news to my two relatives who make up half the readership of these articles. I have also learned over the years to take most things with a grain of salt (particularly if it is followed by a shot of …
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