Practice Management
I don’t know about you, but I’m tired of being talked at about antibiotic stewardship. We all realize it’s a problem. And though it’s common practice to blame urgent care providers for the situation, we aren’t uniquely culpable for antibiotic overuse. To anyone paying attention, it’s clear that antibiotic overprescribing in urgent care remains as rampant as crime in Gotham City. And the topic has become exhausting for UC providers, not because we believe it …
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I got my first guitar when I was 14. It was an Alvarez acoustic with an electric pick-up, and I played it every day—at least for a while. I thought it would make me cool and make the girls take notice. But after about a year, when neither of those things had happened, I just about gave up the guitar for good. There simply wasn’t much joy in always playing alone. What revived and has …
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In the world of urgent care, it’s assumed that we exist to provide immediate, episodic care for discrete problems. The sore throat, sprained ankle, and laceration are our bread and butter. However, we do not practice in a vacuum. We share patients with other clinicians who longitudinally follow and manage their multiple comorbidities. Additionally, for the growing number of patients without a primary care provider, we commonly serve as the sole point of contact with …
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Most urgent care providers loathe when a patient checks in with chest pain because, typically, they are presenting because they’re worried about a heart attack, and we’re worried we don’t have the tools to exclude this diagnosis. It’s no surprise that we’re met with consternation when we suggest they may have come to the wrong place for care. But is unavailability of troponin testing a worthy scapegoat? And is the practice of ED referral for …
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Urgent message: Previously undiagnosed diabetes in elderly patients is too frequently a precursor to the diagnosis of pancreatic cancer. Incidental and unexpected diagnosis of diabetes in older patients in urgent care, especially in normal or underweight individuals, should prompt a discussion about vigilant monitoring for other symptoms of malignancy and close follow-up with a primary care provider. Joshua Russell, MD, MSc, FCUCM, FACEP CASE PRESENTATION A 72-year-old woman with a history of hypertension presented to …
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Pediatric Pneumonia Signs and Symptoms of Cauda Equina Syndrome Removing ‘Stuck’ Rings Central vs Peripheral Acute Vertigo Zinc and Viral RTIs in Adults Nathan M. Finnerty, MD, FACEP; Joshua W. Russell, MD, MSc, FAAEM, FACEP; and Brett C. Ebeling, MD How Long Should Pediatric Pneumonia Be Treated? Take-home point: Lower-dose and shorter-duration amoxicillin treatment was noninferior to standard regimens for outpatient treatment of community-acquired pneumonia (CAP) in this trial. Citation: Bielicki JA, Stӧhr W, Barratt …
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Patient volume has always been a delicate topic between the clinical staff and administrators of urgent care centers. It’s no secret who stands where in this ongoing debate. Regardless of each side’s opinions, UC volume has been largely stochastic historically, fluctuating at its own whim without regard for who wishes it were higher or lower. Things are different now, though. Thanks to COVID, UC overcrowding has become the new ED overcrowding—ubiquitous. The large volumes of …
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Joshua Russell, MD, MSc, FCUCM, FACEP A colleague, Dr. Mitchell we’ll call him, told me about a PA that he was supervising recently who made a great catch in a patient with a swollen, blue finger: Achenbach syndrome. When the PA presented the presumptive diagnosis, Dr. Mitchell, unfamiliar with the condition, had to Google it before seeing the patient. Our PA was right, though. The patient walked out of clinic, happy to have a benign …
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Joshua Russell, MD, MSc, FACEP Until recently, I’ve had the rare luxury of working in busy urgent care centers where I was virtually always working side-by-side with another provider. However, with changes in my career and UC staffing models in the wake of the pandemic, I find myself working in single coverage situations the majority of the time nowadays. While I do miss the camaraderie of multi-coverage practice, I miss the unfettered access to a …
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It’s 8 pm and I’m 9 hours into a 10-hour shift when four new patients walk in. Even though I’m feeling drained, I smile warmly as each passes my workstation. I “eyeball” them each as they walk by; my grin persists because they all seem stable and my “TUR” for this shift in the emergency department is now only 45 minutes away. TUR (or “time until relief”) is a metric I continuously track with ruthless …
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