The Case The patient presented with fever and difficulty swallowing. He was visibly anxious, leaning forward on the examination table and spitting into a cup. View the image taken (Figure 1) and consider what your diagnosis would be.
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Woman with Papules on the Hand
A 40-year-old woman with a history of human immunodeficiency virus (HIV) presents with flat-topped verrucous papules on her hands. Her most recent CD4 count was approximately 150 cells/μL. She notes that she regularly uses sunscreen on her face but not on her hands, and she is wondering whether the lack of sunscreen could be a cause of the lesions. View the image taken (Figure 1) and consider what your diagnosis would be.
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The Great Flu Shot Conundrum
Alan A. Ayers, MBA, MAcc, is Practice Management Editor for JUCM, serves on the Board Directors of the Urgent Care Association of America, and is Vice-President of Strategic Initiatives for Experity. Urgent Message: Flu shots decrease health-care expenses, workplace absenteeism, and lost productivity, so why do most insurers not cover their cost when patients get the shots at urgent care centers? It is time for this practice to change. According to the U.S. Centers for …
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Fracture of the Penis with Urethral Rupture
Urgent message: Failure to diagnose and, if necessary, repair penile fracture can result in devastating consequences such as stricture, fistula, and long-term voiding difficulty. TAYT ELLISON, MS-3, SHAILENDRA SAXENA, MD, PhD, LAURA KLUG, PharmD, and SANJEEV SHARMA, MD Although penile trauma is not a common presentation in the urgent care setting, it is under-reported because of embarrassment, as are other injuries related to sexual activity. The urgent care clinician should be prepared to evaluate these …
Read MoreEvaluating Chest Pain in Urgent Care— “Catch 22 and the Three Bears”: Part 2
Lee A. Resnick, MD, FAAFP In my last column, I introduced a framework for evaluating chest pain in urgent care. In this month’s column I discuss a risk and probability stratification that can assist in disposition decision-making. The following discussion considers existing evidence, but there is no formal guideline for this process in the outpatient setting. Our goal is to make a risky scenario into something we can live with. This model is for risk-stratification …
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Urgent Care Evaluation of Fatigue
Ever heard the old (and not so funny) joke about two health-care providers having a conversation at the urgent care center? First provider: “Ever seen a case of _____?” Second provider: “Turns out I have seen plenty of cases . . . just never diagnosed any!” With a nonspecific presenting condition such as fatigue, it is difficult to obtain an adequate medical history and to perform a thorough physical examination unless the differential diagnosis is …
Read MoreMedical Malpractice Trial, Part 1: The Events
John Shufeldt, MD, JD, MBA, FACEP I recently spent 3 amazing weeks in a medical malpractice trial. Over the next few months, I would like to share the experience with you. Despite the fact that I practice law and have been an expert witness for more than 20 years, the experience opened my eyes and has definitely changed how I practice medicine in the urgent care setting. I took copious notes during the trial and …
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Image Check: Impact of Employee Appearance on the Patient Experience
Urgent message: Patients often infer quality on the basis of outward appearances. Adopting a policy that addresses clothing, grooming, and body art can help balance the need to project a professional image in the urgent care center and to ensure workplace safety with employees’ desire to express themselves. ALAN A. AYERS, MBA, MAcc Practice Velocity Remember the popular 1990s advertising slogan “Image is everything”? What was back then a trendy catchphrase created to peddle expensive …
Read MoreMarch 2015
Fracture Codes, Strapping and Splint Application Codes, S9088
Q. I was told that we can no longer use code 80100 for drug screens. We have several employers who send employees and potential employees to our urgent care center for pre-employment, random, and post-accident drug screens. What code should we use now? A. Effective January 1, 2015, several drug-screen Current Procedural Terminology (CPT) codes were deleted by the American Medical Association: 80100: “Drug screen, qualitative; multiple drug classes chromatographic method, each procedure” 80101: “. …
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