JOHN SHUFELDT, MD, JD, MBA, FACEP Johnny Dalton presented to the emergency department (ED) at St. Jacob’s Hospital after ingesting liquid methadone, a long-acting opioid. Responsive Emergency Medicine and Dr. Beth Ange evaluated and monitored Johnny for nearly 12 hours and discharged him home. Johnny was found dead by his family approximately 20 hours after discharge. Case name: John and Cathy Dalton v. Dr. Beth Ange and Responsive Emergency Medicine Decedent: Johnny Trey Dalton Attorney …
Read MoreMedical Malpractice Trial, Part 1: The Events
John Shufeldt, MD, JD, MBA, FACEP I recently spent 3 amazing weeks in a medical malpractice trial. Over the next few months, I would like to share the experience with you. Despite the fact that I practice law and have been an expert witness for more than 20 years, the experience opened my eyes and has definitely changed how I practice medicine in the urgent care setting. I took copious notes during the trial and …
Read MoreMedical Boards: Part 2
JESSICA HOFFMANN, MS-4, and JOHN SHUFELDT, MD, JD, MBA, FACEP The probability that you will receive a certified letter from your medical board informing you about an investigation is relatively low. But one day, you may be one of the unlucky souls who receives such a letter. What do you do? Different boards have different rules about what gets reviewed or investigated and what does not. Some boards are mandated to investigate, at least to …
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Serious Pathology Masquerading as Chronic Back Pain
Urgent message: Do not be fooled by the diagnosis made by clinicians before you. Many seemingly benign symptoms can be harbingers of more serious pathology. JESSICA HOFFMANN, MS-4, and JOHN SHUFELDT, MD, JD, MBA, FACEP Chronic back pain is a common presentation in both the urgent care and emergency department (ED) settings. Care-on-demand providers often find themselves deciding how extensive a workup to do for a patient with acute-on-chronic back pain. After a patient has …
Read MoreMedical Boards: Part 1
John Shufeldt, MD, JD, MBA, FACEP I have been practicing medicine for nearly 30 years. I have received countless letters from law firms for records requests and notifying our group or me of an impending issue. I’m kind of numb to it. Conversely, anytime I get a letter from the medical board, I go into SVT. I am sure it is the same way with the physician assistant and nursing boards. You just start thinking, …
Read MoreHIPAA Hypos and Privacy Paradigms
John Shufeldt, MD, JD, MBA, FACEP One of the moderately entertaining aspects of law school was answering hypotheticals (“hypos”) in class. They would go something like this: “Mr. Shufeldt, suppose that an off-duty police officer witnesses what she believes is an aggravated assault. Without identifying herself as a police officer, she disarms the assailant and, while doing so, the gun discharges and the bullet strikes and kills a bystander, who happens to be an emancipated …
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Treating Autistic Patients in the Urgent Care Setting
Urgent message: As the number of patients with autism spectrum disorders continues to increase, it is important that urgent care providers proactively educate themselves about how best to provide acute care for these individuals. ELIZABETH MANGONE and JOHN SHUFELDT, MD, JD, MBA, FACEP A 14-year-old autistic male presents with both parents. The patient is non-verbal and hypersensitive to touch. The parents state that he was stung by a bee and seems to be having respiratory …
Read MoreHIPAA for Health Care Heroes
John Shufeldt, MD, JD, MBA, FACEP You are working in an urgent care center when a mother shows up with her 18-year-old daughter, who is “mildly developmentally delayed,” per her mom. The daughter turned 18 yesterday and the mother is concerned that she may have gotten a little “too wild” while celebrating her birthday at a friend’s house and she would like her tested for drugs and STDs. The daughter appears to understand what is …
Read MoreDon’t Drink the Kool-Aid
John Shufeldt, MD, JD, MBA, FACEP I did and not just a little. I guzzled the entire Jim Jones carafe full of it. I was an early electronic health record (EHR) adopter and I loved it! In fact, I still do; however, as with any Kool-Aid (particularly when it’s served in Guyana), you can’t just guzzle it and hope for the best. You have to know what is in it or else it can bite …
Read MoreBayes’ Theorem and Urgent Care Medicine: Why it Matters
John Shufeldt, MD, JD, MBA, FACEP How many times have you encountered a patient who presents with an issue and tells you about a previously diagnosed condition with which he or she is having ongoing symptoms? It happens to me nearly every shift. A 35-year-old male presents with chronic back pain. He has been to your urgent care center a number of times in the past and presents again with a variation of the same …
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