DAVID STERN, MD (Practice Velocity) Q.How would you define the difference between an expanded problem-focused exam and the detailed exam in the 1995 evaluation and management coding guidelines? – Question submitted by Eddie Stahl, Medical Staff Director, Tennessee Urgent Care Associates A.For both the expanded problem-focused exam (EPF) and the detailed exam, the provider must document between two and seven body systems. The difference is that the EPF exam requires a “limited” exam of a …
Read MoreClinical Challenge: March, 2008
The patient is a 15-year-old boy who presented two days after experiencing a blow to both ankles and the right knee. He could bear weight minimally, with tenderness over the lateral and medial malleolus, as well as over the knee. There was marked swelling View the x-rays taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read MoreLearning to be Direct in Sales Negotiations
In 2008, we live in a vastly different world in which we feel information-saturated, overburdened, and pressed for time. It is a world in which long dialogue is generally a nuisance and short, to-the-point interchange is embraced. It is a world that values Headline News, USA Today, and Internet blogs more than traditional news shows or in-depth books. In short, we live in a world in which people want things short, simple, and digestible. That …
Read MoreWhat the Gray Haired Never Shared
JOHN SHUFELDT, MD, JD, MBA, FACEP For some reason, it is likely that no one with gray hair ever sat you down and shared with you some secrets to longevity, productivity, and career success in medicine. Why we in medicine tend to “eat our young” remains a mystery to me. If you have seen the movie 300 or read the book Gates of Fire, you understand that we tend to act very “Spartan-like.” I am …
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The Case of a 10-Year-Old Male with Eye Pain
Other than these medical errors, dyspnea and advanced age were the two most common factors associated with an unscheduled return visit. What is the incidence of bouncebacks? What is the incidence of bounceback admissions? What is the inci- dence of death in patients recently discharged from the ED? What percent of bouncebacks occur because of medical errors? How can we use this information to improve patient safety? This month, we will discuss Question IV: What …
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Understanding Clinical Decision Rules Regarding Minor Traumatic Brain Injury
Urgent message: Patients with minor traumatic brain injury can be difficult to assess. Identifying those at risk for poor outcomes is critically important in the urgent care setting. Joseph Toscano, MD The term traumatic brain injury (TBI) describes various injury patterns that result from force being absorbed by the brain after a rapid acceleration or deceleration or head impact. TBIs can span a spectrum from minor changes to fatal catastrophes and can affect patients in …
Read MoreStrength in Numbers
Lee A. Resnick, MD, FAAFP It’s springtime again, and for us Northerners, that is a welcome sign. It’s time to end months of hibernation holed up in our overly heated homes. It’s time to break out of our winter routine of work, eat, and sleep and welcome in several months of energizing warmth and rejuvenated spirit. At UCA, we use this time of year to re-energize the membership, welcome in new members, and set the …
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30-year-old male in severe discomfort after "twisting" ankle
The patient is a healthy 30-year-old male who presents with pain shortly after “twisting” his ankle while playing soccer. Pain is severe enough to prevent him from putting weight on the ankle. There are no other remarkable findings from exam or patient history. View the image taken and consider what your diagnosis would be.
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3-year-old girl with sudden pain in right hip
The patient is a 3-year-old girl who presented to the urgent care center with right hip pain. She has no fever, and the parents report there was no trauma. The child has a limp and reproducible pain on external rotation of the right hip. White blood count is 11,900 with 40.7 lymphs. The erythrocyte sedimentation rate (ESR) is 3 mm/hour. The x-ray shows fluid around the right hip joint; this finding was confirmed by ultrasound. …
Read MoreClinical Challenge 2: February 2008
The patient is a 3 ½-year-old girl who fell from a bicycle, receiving a blow to the elbow a short time before presentation. She had marked swelling and local tenderness over the elbow. The only other remarkable finding was a pulse of 132. 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.
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