Back in 2008, while the Obama administration was first evaluating healthcare reform, Peter Orszag, then the director of the Congressional Budget Office, estimated that 5% of the nation’s gross domestic product, or $700 billion per year, goes to medical tests and procedures that have no proven positive impact on outcomes. Unaccounted for in this estimate are the billions more spent managing the often lifelong complications inherited from inappropriate tests and unproven procedures. MRIs that identify …
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75-year-old experiencing dysphagia after swallowing bone
The patient, an otherwise-healthy 75-year-old, was eating fish, felt a swallowed bone, and has experienced progressive dysphagia since. View the image taken and consider what your diagnosis and next steps would be
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2-1/2 year-old with recurrent abdominal pain
The patient, an otherwise healthy 2-1/2 year-old, experienced recurrent episodes of abdominal pain without vomiting or diarrhea. On exam, fullness of the abdomen was present. View the image taken and consider what your diagnosis and next steps would be. Click on the button below to see the resolution of the case.
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27-year-old presents a jammed right finger
This otherwise healthy 27-year-old jammed his right finger today. NL distal perfusion. Palpable reduction achieved with traction. Continued instability. Subluxates with flexion. Therefore, placed in splint to return for ortho tonight. View the image taken and consider what your diagnosis and next steps would be. Click on the button below to see the resolution of the case.
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November 2011
Developing Data: November, 2011
These data from the 2010 Urgent Care Benchmarking Survey are based on responses of 1,691 US urgent care centers; 32% were UCA members. The survey was limited to “full-fledged urgent care centers” accepting walk-ins during all hours of operation; having a licensed provider and x-ray and lab equipment on-site; the ability to administer IV fluids and perform minor procedures; and having minimal business hours of seven days per week, four hours per day. In this …
Read MoreNebulizer Supplies, Diltiazem IV, Influenza Vaccines with E/M Codes, and Critical Care Coding in Urgent Care
Q.I am using an EHR, but it does not seem to code nebulizer treatments correctly. It produces codes 94640 (nebulizer treatment) and J7620 (albuterol/ipra – tropium bromide), but it misses the codes for administration set, with small volume non-filtered pneumatic nebulizer, disposable (A7003) and tubing (A7011 ). Why is this? A.The administration set code (A7003) and tubing code (A7011) code are actually bundled into the code for the treatment (ie, they are included in 94640). …
Read MoreAbstracts in Urgent Care: November, 2011
Chinese Herbs Are as Efficient as Oseltamivir for Shortening Flu Symptoms Key point: Traditional Chinese herbal therapy resolves fever in influenza as quickly as oseltamivir. Citation: Wang C, Cao B, Liu Q-Q, et al. Oseltamivir compared with the Chinese traditional therapy maxingshigan-yinqiaosan in the treatment of H1N1 influenza: a randomized trial. Ann Int Med. 2011;155(4):217-225. Researchers studied some 400 adults and adolescents in 11 Chinese hospitals who had uncomplicated 2009 H1N1 influenza A. Patients, who …
Read MoreClinical Challenge: November, 2011
The patient, an otherwise healthy 45-year-old, has had a cough for a month. Location: left side of the chest. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
Read MoreAequanimitas*
“Thou must be like a promontory of the sea, against which, though the waves beat continually, yet it both itself stands, and about it are those swelling waves stilled and quieted.” —Marcus Aurelius It is important to reflect occasionally on where one’s path began inasmuch as we owe a debt to those who have advanced our current purpose, whether family, business, or profession. The goal of this reflection should hopefully include an appreciation of …
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