Practice Management
This patient presented with a two-hour history of intense pain and redness along the left side of her head and down her left arm. She reported no exposure to unusual foods, plants, or substances, and denied any additional complaints. History and examination reveal no other remarkable findings. View the image taken and consider what your diagnosis and next steps would be.
Read More
Urgent message: Making the best use of the space you have is not just a matter of comfort and esthetics; an efficient floor plan contributes to providing proper—and cost-effective—care and services. Patrice Pash, RN, BSN, COHC So you’ve signed the lease or purchased the property and you’re sitting there staring at this huge empty shell, dreaming of the potential finished space. What will it look like? How many exam rooms do you need? What additional …
Read More
In primary care medicine, patients’ symptoms are approached from the “front door;” what are the most likely causes? Urgent care medicine often starts with a “back door” approach; think “worst first,” then proceed backward through the differential after excluding life threatening causes. Urgent care does not have the luxury of an established patient relationship or defined return visit we often have only one chance to get it right! The differential for an urgent care patient …
Read More
Urgent message: Acute injuries to the foot often send patients to an urgent care center—though on occasion they don’t present for weeks, or even months, after the injury occurred. Understanding the natural history of untreated fractures in the foot is imperative to positive outcomes. The first in a two-part series. Phillip H. Disraeli MD, FAAFP This article will focus primarily on two aspects of care: 1. Proper management of and follow-up for simple nondisplaced fractures …
Read MoreI expected a firm retort from our colleagues in academic and traditional family medicine with regard to my column Is Urgent Care “Real” Family Medicine? (JUCM, October 2008). Unexpectedly, however, the column brought concern from one of our urgent care colleagues with roots in emergency medicine. In his letter—excerpts from which are presented here—Dr. Bryan Dunn of Boerne/Bulverde Urgent Care in Texas writes: “Your editorial came across as a slap in the face to emergency …
Read MoreIn 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: How much money do physicians who work in urgent care centers make? …
Read MoreDAVID STERN, MD (Practice Velocity) Q.Our doctor saw a patient for a sore throat. The rapid strep screen was positive, so she placed the following diagnoses on the chart: 0: Streptococcal sore throat 61: Fever presenting with conditions classi- fied elsewhere 1: Throat pain 79: Other malaise and fatigue I told her that since we had a specific infection that was the cause of second, third, and fourth diagnoses, we should code the confirmed infection, …
Read MoreED Crowding Adversely Affects Patient Satisfaction Key point: Dissatisfaction lasts throughout entire hospital stay. Citation: Pines JM, Iyer S, Disbot M, et al. The effect of emergency department crowding on patient satisfaction for admitted patients. Acad Emerg Med. 2008;15:825-831. Recent studies on emergency department overcrowding have shown adverse patient outcomes when patients are boarded in the emergency department. To address how patient satisfaction relates to ED overcrowding, these authors retrospectively reviewed Press Ganey satisfaction surveys …
Read MoreThe patient is a 55-year-old female who experienced a blow to the back when she fell while riding a bus. She complains of pain in her neck, shoulder, and back. On examination, you find that her vitals are stable and she has no significant past medical history. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. (Hint: this …
Read More