StuWilli, Author at Journal of Urgent Care Medicine

Understanding the True Value of the Occupational Health Product

Your clinic needs to sell occupational health services based on their perceived value to the buyer. Hence, you must learn to assess each buyer’s perception of what constitutes value to them before discussing your services. Traditionally, such an assessment is done through the use of astute questioning (e.g., “What is most important to you in selecting an external provider of occupational health services?”). Once you have an understanding of what motivates the prospective buyer, only …

Cleared for Takeoff

JOHN SHUFELDT, MD, JD, MBA, FACEP I like checklists. I use them while treating patients, flying, cooking, and training. Despite the fact that I have a few thousand hours behind the controls of a variety of aircraft, I still use them every time I fly. Why then, if I believe I am a fairly competent pilot, do I need to rely on something as pedestrian as a checklist for things that I have done countless …

Coding for Rectal Strep and Injury Exposure Visits, Billing for Slit Lamp Exams, and a Follow-up on Splinting

DAVID STERN, MD (Practice Velocity) Q. What is the correct ICD-9 code for rectal strep? Question submitted by Cindy Reisbeck, Littleton, CO A. There are several possible codes. The specific ICD-9 code would depend on a more specific diagnosis. For streptococcal infections in the rectal or perirectal area, there are several possible correct codes, as streptococcal species can cause multiple different types of localized conditions. For cellulitis, the correct code would be 566; for erysipelas, …

Clinical Challenge: September, 2010

In each issue, JUCM will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of dermatologic conditions that real urgent care patients have presented with. If you would like to submit a case for consideration, please e-mail the relevant materials and presenting information to [email protected]. The patient is a 62-year-old who presents with a primary complaint of right shoulder pain that developed over time. The patient denies any trauma. The patient is …

Promethazine-induced Tissue Necrosis: A Case Presentation

Urgent message: Due to versatility, the urgent care clinician will find promethazine an appropriate choice in many situations. Awareness of potentially serious side effects maximizes the chance of good outcomes while minimizing risk. Shailendra Saxena, MD, PhD, Naureen Rafiq, MD, Liji George, MD, Cara Olsen, PharmD, and Mikayla Spangler, PharmD Introduction Promethazine (Phenergan) is a drug commonly prescribed in emergency departments and urgent care clinics for treatment of a variety of conditions (Table 1). Because …

Providing DOT Medical Certification Exams for Commercial Drivers

Urgent message: The Department of Transportation’s responsibility to ensure that commercial drivers are physically qualified to operate in interstate commerce can mean new business for urgent care providers who qualify to perform certification exams. Ellison H. Wittels, MD, FACP The Federal Motor Carrier Safety Administration (FMCSA) – one of nine operating administrations within the United States Department of Transportation (DOT; Table 1) – is tasked with regulating commercial trucks and buses in interstate commerce. That …

Physician Recruiting: Standing Out in a Crowd

Urgent care is growing by hundreds of centers each year, and available physicians are declining with equal speed. urgent care training is variable, at best, and urgent care experience is hard to find. Expanding health systems with their in-house recruiters and high visibility are tightening the squeeze. All told, it’s a recipe for unfilled positions and staff burnout. Whether you are looking to expand locations, add providers, or replace departing ones, you are bound to …

20-year-old female with knee pain after fall

The patient is a 20-year-old female who presents with pain one day after falling and experiencing a blow to the knee. Examination reveals no significant findings beyond mild local tenderness. She is able to bear weight fully on both legs. View the image and consider what your diagnosis and next steps would be.

16-year-old male experiencing chest and throat pain

The patient is a 16-year-old male who presents with difficulty breathing, pain in his throat, difficulty swallowing, and pleuritic chest pain. He reports that the symptoms began “a couple of hours” earlier. There is no history of trauma, choking, or recent dental procedure. The patient looks well, and is quiet and not toxic. Pulse is 75, O2sat 94; there is no fever. Chest is normal, with bilateral air entry. Assessment is hindered by the patient’s …

93-year-old female with a twisted ankle

The patient is a 93-year-old female who lost her balance and twisted her ankle. She presents with significant pain in the ankle and swelling over her lateral ankle, though she is able to bear weight. View the image and consider what your diagnosis and next steps would be.