Journal of Urgent Care Medicine

What’s In a Test? The Psychology of Patient Expectations

Lee A. Resnick, MD, FAAFP The impact of patient expectations and pressures on high utilization rates in this country is a subject of significant discussion but surprisingly little study. A literature review produces scant evidence of scientific inquiry in this area. And yet, most clinicians would say that patient expectations are perhaps an even stronger motivation for utilization than fear of malpractice suits. In an ever-competitive, service- oriented industry like urgent care, this can only …

Physicians Criticizing Physicians: A Two-Headed Snake

Lee A. Resnick, MD, FAAFP In the Hippocratic Oath it is written and we are bound: “To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art if they …

Dare We Doubt the Wisdom of Patient Empowerment?

Lee A. Resnick, MD, FAAFP “Patient empowerment,” “patient-centered care, “patient-focused care,” and “shared medical decision-making” are among a growing number of terms intended to shift the power and control of healthcare decisions from physicians to patients. The concepts are, for all intents and purposes, accepted as “good.” It is merely assumed that empowered patients are better off than those who defer control of their healthcare decisions to their clinicians. Despite an almost revolutionary change in …

The ED Utilization Debate: Can a Shell-Game Redirect the Scrutiny?

Lee A. Resnick, MD, FAAFP You might not expect one of our most prestigious medical journals to be susceptible to scientific sleight of hand. But the JAMAeditorial board apparently fell victim to just that in publishing the latest in a string of self-serving, extraordinarily biased “studies” supported by the American College of Emergency Physicians (ACEP), entitled “Comparison of Presenting Complaint vs Discharge Diagnosis for Identifying “Nonemergency” Emergency Department Visits.” The study’s objective was to determine …

Judgment Day

Lee A. Resnick, MD, FAAFP Carl Jung said, “We should not pretend to understand the world only by the intellect. The judgment of the intellect is only part of the truth.” In medicine, reliance on intellect alone is a significant danger. Ignorance of cultural, social, and even psychological context can mislead the clinician and risks misdiagnosis and error. Yet the very basis of medical decision-making is rooted in the rule of intellect. Evidence-based medicine is, …

“You Can’t Always Get What You Want…” “…but You Get What You Need!”

Lee A. Resnick, MD, FAAFP Love, politics and drugs were the subjects of Mick Jagger’s self-reflection in the 1960s rock anthem, “You Can’t Always Get What You Want.” Since then, the song’s chorus has been reproduced and repurposed into everything from parenting advice to sociology lectures. Mick’s personal struggles with drugs and other temptations are referenced frequently as the artistic purpose of the song, and while he may not have intended greater ideological meaning, I …

Patient Portals Part II: ‘Who’s That Practice Behind the Curtain?’

Lee A. Resnick, MD, FAAFP I proposed a systematic approach intended to in my last column, I discussed the decision- making process around patient portals and mitigate risk, ensure security, and manage access. A portal, by definition, is an‘entrance‘— a virtual access point to a practice, its staff and patient medical records. The most common access point is a practice’s website and well-designed one can enhance access, improve efficiency, and help sell your practice to …

Electronic Patient Portals: Access or Anarchy?

I to choose a direction of flow that least the “path of least resistance” is a physical property that represents an object’s tendency impedes its forward momentum. No other healthcare entity has better captured this principle than urgent care. In traditional health systems, patient flow is infamously disrupted by obstacle some regulated, some self-imposed, some unavoidable. These “flow disrupters” are the very reason urgent care exists. Consider this: Nothing we offer in urgent care is …

The Hidden Costs of the Professional Liability Crisis

As we head into a new year at JUCM, our tenth, it is a natural time to reflect on our journal’s history and our goals for the future. Just being able to celebrate a 10th anniversary is nothing short of a miracle. Medical publishing has been in transition for some time, and the number of traditional journals is decreasing. Information, even complex clinical information, is now available with the click of a button. Considering the …

Show Me the Money: Alternative Access in Acute Care Delivery

Lee A. Resnick, MD, FAAFP In my last column I examined the recent study by the Center for Studying Health System Change which reviewed data from the 2008 National Hospital Ambulatory Medical Care Survey (NHAMCS). I identified critical flaws in the definitions used to distinguish “appropriate” emergency department (ED) visits from “non-urgent” or so-called “routine” visits. I concluded that the study missed a tremendous opportunity to identify alternatives for the vast majority of patients with …