Developing Data: September, 2007
UCA’s Survey Committee has conducted two annual member surveys, to date, designed to establish benchmarks in an industry for which data have been sorely lacking. Each month in Developing Data, we will share one or two tidbits from the second annual survey in an effort to help readers get a sense of what their peers are doing, and what kind of trends are developing as urgent care evolves. In this issue: How much time do …
Read MoreCoding for Removal of Impacted Cerumen (69210)
Q.What is the correct use of CPT code 69210 (removal impacted cerumen [separate procedure], one or both ears)? – Question submitted by Kathy Partenheimer, Medical of Dubois A.In the July 2005 issue of CPT Assistant, the AMA clearly indicates that you should report 69210 onlywhen the following two criteria are both met: “the patient had cerumen impaction” “the removal required physician work using at least an otoscope and instrumentation rather than simple lavage” [emphasis added]. …
Read MoreAbstracts In Urgent Care: September, 2007
Evaluating Fever of Unidentifiable Source in Young Children Key point: An excellent review of the approach to the febrile child. Citation: Sur DK, Bukont EL. Am Fam Physician. 2007;75:1805- 1811. Even with a thorough history and a complete physical examination, one in five acutely ill, nontoxic-appearing children had an unidentifiable source of fever. Physicians should be cautious in their approach because of the potential for unrecognized and untreated serious bacterial infections (SBI). The review notes …
Read MoreClinical Challenge: September, 2007
The patient is a 10-monthold child who presents, with the parents upon referral by the pediatrician, with a history of three days of pain, but no history of trauma. The child refuses to stand, presumably due to pain, and resists crawling. 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.
Read MoreTop Communicators Apply These Principles
Who among your network of colleagues and friends do you consider to be “great communicators?” What characteristics do they have in common that make them great? Consider the following principles underlying one’s ability to communicate effectively: Keep it simple. Break every message down to a simple, easy-to-digest concept. Avoid too much detail or trying to jam too many concepts into a single interchange. Use basic, short words. Assume your subject has a minimal attention span. …
Read MoreEmployment Contracts Part 2: Troublesome Clauses
Congratulations, you have found the perfect job! The chemistry is right, the pay is adequate, and the working environment is somewhat better than a sweatshop. So what’s missing? Ah yes, the contract—that little document designed to protect both parties in the event of a disagreement. Although that description sounds innocuous, employment contracts are usually written by employers and tend to be slanted to their needs, as opposed to those of the employee or contractor. Therefore, …
Read More
The Case of a 33-Year-Old Male with Abdominal Pain
Over the next few installments of this series, we will be discussing “bounceback” studies, and answering the following questions, in sequence: What is the incidence of bouncebacks? What is the incidence of bounceback admissions? What is the incidence of deaths 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? Our feeling is that if we can use these …
Read More
Managing Heat Illness in Urgent Care
Urgent message: The urgent care provider’s most critical role in heat illness is to identify risk factors and the cause, to cool and hydrate the patient, assess for complications, and educate the patient in the hope of preventing a more serious exposure. Bridget Dyer, MD, Samuel Keim, MD, and Peter Rosen, MD Heat illness occurs when external heat conditions and internal heat production overwhelm the ability of the body to dissipate heat. Evaporation of sweat …
Read MoreLessons Learned
Lee A. Resnick, MD, FAAFP Between sticky ribs and spicy BBQ sauce, I mingled with the future generation of doctors at the annual AAFP Residents and Students Conference in Kansas City. I was reminded of several very important things… I am old I didn’t just finish my residency I need to get a “MySpace” account and learn how to “IM.” In addition to my mini-mid-life crisis, my booth was dead. I was sure there would …
Read More