Practice Management
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 …
Read More
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 …
Read More
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 …
Read More
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 …
Read More
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 …
Read More
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 …
Read More
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 …
Read More
Taylor wore her embroidered sorority sweatshirt and a mask below her nose when she came to see me. She was 19 and had just finished her freshman year at the local university. Her story was cliché, as well: cough, runny nose, and sore throat “that wouldn’t go away.” She’d been sick for 8 days and she’d come in to get antibiotics. This isn’t a story about antibiotic stewardship, though. “Have you been tested or vaccinated …
Read More
Remember the fall of last year—when the nation and world pined for an expedient end to 2020, as if such an arbitrary change as turning a page on the calendar could somehow reverse our collective fortune? Unsurprisingly when January 2021 arrived, all our woes were not magically and immediately remedied. In fact, the start of this year was among the most grim in U.S. history: nearly a quarter of a million new cases were being …
Read More
I took up smoking for about 6 months in college, but not for the reasons you’d guess. This was during my freshman year shortly after I got a job waiting tables. It was a hard job. There was always work to be done—refill a drink, check how the food was cooked, and, most importantly, bring the check post-haste when the customers wanted to leave. The shifts always seemed like a blur. I’d run around non-stop …
Read More