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 …
Read MoreSmile! You’re on Candid Camera
John Shufeldt, MD, JD, MBA, FACEP A 34-year-old patient presents with an acute exacerbation of chronic low back pain. A cursory review of his medical records done before seeing him reveals that he has had multiple visits to your urgent care for a variety of complaints including: Flank pain and blood in his urine Dental caries Gout Headache Low back pain Knee strain He typically shows up about 5 minutes before closing and is always …
Read MoreThe First Thing We Do, Let’s Kill All The Lawyers
DAVID WEIN, MD, MBA, FACEP, and DENNIS DIXON, MD I knew that would get your attention! Actually who Shakespeare was referring to in Henry VI was only the rare corrupt lawyer. Corrupt or not, the one thing lawyers have correct is that because their entire practice is “giving advice,” they rarely do it for free. Bad advice has consequences. I’m not trying to be Doctor Downer but in medicine and law, it’s called negligence. As …
Read MoreScribes in the Urgent Care
DAVID WEIN, MD, MBA, FACEP, and DENNIS DIXON, MD For years I was subjected to corporal punishment at the hands of nuns who used to beat me when they could not read my handwriting – at least that is how I remember it. For reasons unknown, my handwriting was never legible. Even back in the day, using the T-System’s “slash and check” charting, my medical records looked like I had either DTs or Benign Essential …
Read MoreMedical Malpractice Insurance: Read the Fine Print
JOHN SHUFELDT, MD, JD, MBA, FACEP Our emergency medicine group was informed that a new corporate mandate will force us to nearly double our malpractice coverage from $1 million for each occurrence and $3 million in yearly aggregate ($1M/$3M) to $2M/$4M. This mandate came despite our group’s low malpractice claims history, a higher burden of proof for plaintiffs in the state where we practice, and a very “doctor-friendly” malpractice environment in our county. To my …
Read MoreMalpractice Trends in Urgent Care and Retail Medicine
JOHN SHUFELDT, MD, JD, MBA, FACEP with ANDREW SNIEGOWSKI, RN, JD CANDIDATE 2014 Over the last 6 years I have written a number of articles on medical malpractice in urgent care medicine. The good news is that I am seeing fewer cases despite the fact that there are more urgent care centers and more patient visits. The bad news is that I am still seeing the same fact patterns time and again. Failure to diagnose …
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Treating the Self-Harming Patient in the Urgent Care
JOHN SHUFELDT, MD, JD, MBA, FACEP He watched her walk through the door at the end of a long, busy day. She was an attractive, well dressed, athletic-looking young lady with a warm smile, the kind of girl he’d want his teenage son to date someday. “Slam dunk,” he thought. “This will be a quick visit and I’ll still get out on time.” The front office team registered her quickly. He suspected that they, too, …
Read MoreObamaCare Update or Fear and Loathing: The Affordable Care Act
JOHN SHUFELDT, MD, JD, MBA, FACEP In the conclusion of my October 2012 column on ObamaCare I wrote that no matter the outcome (of the presidential election) our future will not be boring. Fourteen months later, it has not been boring and we are just around the corner from imposing the individual mandate (aka tax penalty) on those who don’t have minimal insurance coverage. However, before we cross the starting line let’s review a bit …
Read MoreHelp me understand…
JOHN SHUFELDT, MD, JD, MBA, FACEP lease don’t share this with anyone but truth be told, I love paramedics. I sometimes thought I had it bad (I really didn’t think that, but it makes the story better if I sound tragic) treating the myriad disenfranchised in an inner city ED until I talked with the paramedic who wrestled the feces-covered, bath salts and meth-using, naked, combative maniac who was my patient the previous night. (The …
Read MoreUsing Physician Extenders
JOHN SHUFELDT, MD, JD, MBA, FACEP You breathe a deep sigh of relief after learning that you were not the treating provider of a patient who came into your urgent care center and had an unexpected bad outcome. The patient was seen by your mid-level provider who works on opposite days from you in your center. As documented in the medical record, the patient sounds benign: a 28-year-old female who presented with continued sinus symptoms …
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