JOHN SHUFELDT, MD, JD, MBA, FACEP One of my favorite Seinfeld exchanges is this prickly dialogue between George and his fiancée, Susan, regarding his disdain for (and challenge with) condoms: GEORGE: Oh, no, no … condoms are for single men. The day that we got engaged, I said goodbye to the condom forever. SUSAN: Just once … for the make-up sex. GEORGE: Make-up sex? You have to have that right after the fight, we’re way …
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The Case of a 49-Year-Old Woman with Pleuritic Chest Pain
In our last Bouncebacks article, we explored the difficulties that arise when the patient and doctor disagree on treatment through the case of a 28-year old pregnant patient who left against medical advice (JUCM, February 2009). In the second part of this series, we present a case which explores differences in expectations between a patient and the physicians.
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Management of Hypertensive Urgency in an Urgent Care Setting
Urgent message: Effective management of patients presenting to urgent care with acute high blood pressure starts with differentiating between hypertensive emergency and hypertensive urgency and ends with appropriate treatment and counseling. Sanjeev Sharma, MD, Christy Anderson, PharmD, Poonam Sharma, MD, and Donald Frey, MD Introduction Urgent care physicians routinely encounter patients with high blood pressure, but management – particularly for those patients with precarious elevations – remains controversial. Alternative options involve the use of various …
Read MoreThe Responsibility of Torch Bearing
It is a time-honored Olympic tradition: passing the torch around the world from one runner to another, until it reaches the Olympic venue and lights the Olympic flame that burns for the duration of the games. It is a real privilege to carry the torch, and only a select few can be chosen for the honor. Each runner has a few simple tasks: run a few miles with the torch, try not to stumble, avoid …
Read MoreModifiers for E/M Codes During Global Periods
Q. What is the official definition of “global period” as it applies to procedures in the urgent care center? When can we code an E/M in addition to the procedure? A. The actual definition of the global period differs slightly when it is defined by the AMA (CPT) and when it is defined by CMS (Medicaid/Medicare). CPT codes are published and copyrighted by the AMA. According to CPT as it applies to services rendered in …
Read MoreDeveloping Data: April, 2009
In early 2008, UCA revamped its annual survey in conjunction with researchers at Massachusetts General Hospital and Harvard University with the goal of assuring that the UCA Benchmarking Committee’s efforts produced a scientifically valid report. Over the coming months in Developing Data, JUCM will present some of the findings from this landmark survey, to which 436 urgent care centers responded. In this issue: What percentage of urgent care physicians rely on clinical guidelines for treatment …
Read MoreClinical Challenge: April, 2009
The patient is a 17-year-old male who presents with a complaint of throat pain. He reports a history of colitis, for which he was treated with mesalamine and prednisone, 20 mg/day. On exam, you discover that he is also experiencing pressure over his chest. Blood pressure is 97/60, pulse is 93, and SAT is 97%. He is afebrile. you find no abnormalities except for crepitations over his left shoulder soft tissue. View the x-ray taken …
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14-year-old takes a fall onto her ankle
The patient is a 14-year-old who took a fall two hours before presenting. The left ankle is swollen, painful, and unable to bear weight, but the patient is otherwise healthy. Further examination reveals nothing remarkable. View the x-ray taken and consider what your diagnosis and next steps would be.
Read MoreProtecting Your Position as Market Leader
It’s great to be on top, but when a clinic is “fat and happy,” its focus on sales and marketing can lose its intensity. Consequently, your clinic may be in danger of losing its crown without realizing your leadership position is in jeopardy. This month’s column addresses this dilemma faced by urgent care clinics that are market leaders. Instead of assuming that the “best offense is a good defense,” in some cases the best defense …
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33-year-old male with new lesions on lips
The patient is a 33-year-old homosexual male who presents complaining of new lesions on his lips. The patient reveals that he recently engaged in sexual relations with a new partner. Other than concern over the new lesions, he feels well and you find that his vital signs are normal. On examination, you find no skin lesions other than those at the mucosal aspect of the lips, where there are dozens of asymptomatic, superficial papules ranging …
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