Practice Management
David Gahtan MS, PA-C and Joshua Russell, MD, MSc, FCUCM, FACEP Whether we like it or not, electronic medical records are here to stay. And their takeover has been swift. Over recent decades, the EMR has gone from an obscure, bare-bones, often clunky digital notepad to a ubiquitous and powerful tool which tracks enormous amounts of patient data. To continue to practice medicine, we’ve had no choice but to go along for the ride. It’s …
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Eric Ellis, MD Something is amiss in how smaller urgent care operators are reimbursed these days. This, likely, is not news to you and I’m sure my situation is not unique, but in the process of having opened a group of urgent care centers around Sacramento, CA over the past few years, I’ve been shocked about just how bad things are. When we opened our first center, I used a management company to help with …
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Guy Melrose, MB, ChB It was with great interest that I read Dr. Joshua Russell’s opinions on the value of repeating vital signs in the urgent care setting in the November 2022 issue of JUCM.1 Having stated that this does not seem to be common practice amongst his peers, he went on to highlight a couple of very reasonable scenarios in which he recommended repeating vital recordings. Importantly, he alluded to the often-underappreciated phenomenon of …
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John J. Koehler MD, ABPM(OM) I trained in Emergency Medicine in the 1980s and learned to use a slit lamp as an intern; it’s a skill that continues to serve me to this day. We had “opti-spuds” to remove foreign bodies and “opti-burrs” to debride rust rings. This was considered a core skill in my training. This is why, when I started Physicians Immediate Care in 1987, I bought a slit lamp as well as …
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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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The January 2022 issue of JUCM led off with an editorial by Editor-in-Chief Joshua W. Russell, MD, MSc, FCUCM, FACEP about what he called “actually the epidemic that is decimating the healthcare workforce” and “a silent killer of healthcare careers.” He was referring to toxic positivity, or the practice of “encouraging” someone—in this case healthcare providers in the midst of the COVID-19 pandemic—to find and focus on the bright side rather than dwell on withering …
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Sal D’Allura, DO, FAAFP “It’s lonely being the defendant in a medical malpractice case.” Truer words were never spoken. At some point in our careers, the majority of us will be named in a medical negligence case. The unfortunate reality is that medicolegal issues will arise as a part of our professional lives along with a multitude of negative emotions (which inevitably spill over into our personal lives) when we stand accused. These negative feelings, …
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Stephen L. Adams, MBChB, FRNZCUC Like the rest of the world, New Zealand (and more particularly its healthcare system) has been changed, perhaps irrevocably, by COVID-19. Despite a relatively small direct effect on the population (0.06% infected, half of which were identified and isolated at border) with 0.0004% deaths1 (including one physician), the effects on primary care have been substantial. THE BEGINNING New Zealand clinicians were first notified of the Wuhan cluster in January 2020. …
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Andrew Grock, MD; Manuel Celedon, MD; and Jonie Hsiao, MD It was with great interest that we read Most Clinicians Are Still Not Comfortable Sending Chest Pain Patients Home with a Very Low Risk of 30-day Major Adverse Cardiac Event (MACE) by Dr. Michael Weinstock, et al in the February 2021 issue of JUCM.1 In this study, the authors surveyed attendants at an emergency medicine conference in 2018 as to their comfort level discharging patients …
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To My Colleagues: I am writing to alert you to an ominous and pernicious trend in our industry that we must collectively address or we will face marginalization or even extinction in the years ahead. This may sound alarmist, but please hear me out. I opened my first clinic in 1987 when “urgent care” was barely a recognized term. I was there when the Urgent Care Association (at that time known as the Urgent Care …
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