Practice Management
The patient is a 68-year-old woman who presents with a rash she says developed on her trunk over a span of several weeks. On examination, there were multiple confluent, orange-red plaques on the trunk and arms with “islands of sparing” within them. The rash had a primarily truncal distribution and was pruritic. She was feeling well otherwise. View the image and consider what your next steps and diagnosis would be. Resolution of the case is …
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The patient is a 15-year-old boy who presents to urgent care with a painful medial right elbow he and his parents attribute to pitching in a baseball game earlier in the day. View the images taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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Urgent message: As we see a shift to an overwhelming female workforce in urgent care, it is essential that urgent care operators understand the conditions of, and develop policies to be compliant with, employment laws requiring equal pay among genders. Alan A. Ayers, MBA, MAcc, is President of Experity Networks and is Practice Management Editor of The Journal of Urgent Care Medicine. INTRODUCTION Many urgent care centers already pay the same hourly rate for all …
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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 …
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If you read Evaluation of Healthcare Disparities in Urgent Care: A Case Example for Bacterial Pneumonia—see page 23 of this issue—you know that the proportion of appropriate prescriptions written for an on-label medication (in this case, doxycycline for bacterial pneumonia) may differ among various demographic groups. While the conclusions of that study do not necessarily make a cause-and-effect connection, the data should inspire some analysis as to possible rationale for differences for care of various …
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Urgent message: It is common for transgender patients to have a history of poor experiences with healthcare providers. As such, they may be less likely to have an ongoing clinical relationship with a primary care provider, making urgent care a likely destination when a need arises. Familiarity with issues facing adolescent transgender patients, in particular, can benefit both the provider and the patient. Timothy McGinnis and Emily Montgomery, MD THE CASE A 15-year-old transgender male …
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The patient is a 36-year-old male with a history of tobacco and alcohol use who presents to urgent care with sudden-onset substernal chest pain and shortness of breath that began 1 hour prior to arrival. View the ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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The patient is a 43-year-old male who presents with a painful collection of pus near his fingernail. He reported that it had developed over the past day. On examination, a large, yellow-green superficial pus collection was seen at the proximal nail fold with surrounding erythema and edema. The patient mentioned that he had a home renovation business and that it was common for him to experience mild injuries such as splinters on his hands. The …
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The patient is a 47-year-old male who presents with a primary complaint of right ankle pain after a pick-up game of basketball. He reports he twisted his ankle when he landed on another player’s foot. View the images taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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Urgent message: Acute or chronic hallux pain is a common complaint in urgent care. Due to the structure, several diagnoses can have similar presentation on history and exam. With this discussion, we examine a sesamoid stress injury. Sergio P. Ramoa, MD, MS INTRODUCTION The tibial (medial) and fibular (lateral) sesamoids are contained within the flexor hallucis brevis tendons along the metatarsal head.1 They have several roles such as absorbing weight, helping glide and reducing friction …
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