Practice Management
“Do as little as necessary, not as much as possible.” This is the mantra I recite throughout every urgent care shift without fail—that’s how mantras work after all. Hearing the word “mantra” might conjure images of a placid-faced yogi seated in the lotus position for some, but a mantra needn’t serve only spiritual practice. A well-conceived mantra can also prove useful when deployed in any context where we might benefit from being reminded frequently to …
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Recently one evening, I meandered into a bar on iconic 6th Street in Austin, Texas— America’s epicenter for live music. Venues throughout the district feature free, live performances every night from some of the nation’s most talented musicians. On that particular evening, however, the sounds from one electric guitar coming from a small stage in a dark room cut through the humid air and grabbed my attention. I wandered in, found a seat at the …
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Joshua Russell, MD, MSc, FACEP, FCUCM “It only hurts right here,” Rich told me, pointing to a tender spot on his ribs under near his arm pit. I palpated his chest wall and observed as he winced when I hit the spot. “I just need to make sure I’m okay to go back to work.” Rich was middle-aged and had a mustache with hints of grey. He was a large man, but his potbelly was …
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Joshua Russell, MD, MSc, FCUCM, FACEP Who among us has worked a single urgent care (UC) shift without at least one patient making a humble request for a sick note to take back to work? “Can I have a work note?” It’s a simple ask. In fact, apart from medication refills, work note visits rank among the most welcomed presentations for many overworked clinicians, offering a much-needed mental reprieve and a chance to finally catch up …
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Joshua Russell, MD, MSc, FCUCM, FACEP In its most modern form, medicine revolves around action. We are trained as clinicians to assess, diagnose, and intervene, but it’s the intervention part that patients expect most. This is especially true in urgent care (UC), where patients usually present in anticipation of some swift action for whatever is bothering them. I recently saw a healthy, middle-aged man in our clinic who was complaining of some mild chest pain. …
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Joshua Russell, MD, MSc, FCUCM, FACEP Click Here to download the article PDF Sophie was back with another one of her kids in tow. This was the fifth time in a month. I could almost hear my staff roll their eyes when she walked through the door. Even though she was a denizen of the clinic, I was about to meet her for the first time because I usually covered other sites. Although I was …
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Click Here to download the PDF In the macro and “dot phrase” era, there are many refrains that appear in the electronic medical record (EMR) with such regularity that we don’t even notice them anymore. Statements like All questions were answered prior to discharge, The patient verbalizes understanding and is comfortable with the plan, and Symptomatic care and over-the-counter treatments discussed are so commonly tacked onto charts that our eyes have been trained to gloss …
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I had time to see one more patient as my shift was winding down. “Wound check. That should be a quick one,” I said to myself. Famous last words. I soon learned that the young woman with the dog bite on her hand was returning for her fourth visit in as many days for the same issue. She sat fidgeting on the exam table and was visibly irritated when I walked in the room. “It’s …
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Joshua Russell, MD, MSc, FCUCM, FACEP I didn’t want to send her to the ER, but what else could I do? Mrs. C was a gaunt 72-year-old Chinese-American woman who had never been to our clinic before. Her son carried her in at 7:56 pm like a bride across the threshold. “She cannot walk,” he said, startling the MA sitting at the front desk. “Has she been seen here before?” our MA asked …
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Joshua Russell, MD, MSc, FCUCM, FACEP I’m just going say it: we should repeat vital signs more often in urgent care. But from the odd looks I get whenever I work with a new medical assistant, I realize that asking for vitals to be rechecked isn’t common practice among my colleagues; it may even be frankly contrarian. So, before I lose you, I’ll concede that one set of vital signs is more than enough for …
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