The patient is a 17-year-old male who presents with a complaint of throat pain. He reports a history of colitis, for which he was treated with mesalamine and prednisone, 20 mg/day. On exam, you discover that he is also experiencing pressure over his chest. Blood pressure is 97/60, pulse is 93, and SAT is 97%. He is afebrile. you find no abnormalities except for crepitations over his left shoulder soft tissue. View the x-ray taken …
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14-year-old takes a fall onto her ankle
The patient is a 14-year-old who took a fall two hours before presenting. The left ankle is swollen, painful, and unable to bear weight, but the patient is otherwise healthy. Further examination reveals nothing remarkable. View the x-ray taken and consider what your diagnosis and next steps would be.
Read MoreProtecting Your Position as Market Leader
It’s great to be on top, but when a clinic is “fat and happy,” its focus on sales and marketing can lose its intensity. Consequently, your clinic may be in danger of losing its crown without realizing your leadership position is in jeopardy. This month’s column addresses this dilemma faced by urgent care clinics that are market leaders. Instead of assuming that the “best offense is a good defense,” in some cases the best defense …
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33-year-old male with new lesions on lips
The patient is a 33-year-old homosexual male who presents complaining of new lesions on his lips. The patient reveals that he recently engaged in sexual relations with a new partner. Other than concern over the new lesions, he feels well and you find that his vital signs are normal. On examination, you find no skin lesions other than those at the mucosal aspect of the lips, where there are dozens of asymptomatic, superficial papules ranging …
Read MoreAbstracts in Urgent Care – March 2009
Beware of Eyewitness Accounts of Syncope or Seizures Key point: Bystanders’ descriptions of acute neurologic events often are simply wrong. Citation: Thijs RD, Wagenaar WA, Middelkoop HAM, et al. Transient loss of consciousness through the eyes of a witness. Neurology. 2008; 71: 1713-1718. Diagnosis of sudden catastrophic illness depends a good deal on eyewitness accounts. But, as criminologists know, eyewitnesses can be unreliable. Now, a team of neurologists in the Netherlands has reconfirmed this finding. …
Read MoreEvaluation and Management of Lower Extremity Edema
Urgent message: The high specificity but broad range of possible causes associated with a primary complaint of lower extremity edema poses a particular challenge to the urgent care clinician. Proper assessment of the differential diagnoses is the first step toward optimal outcomes, whether they be facilitated by treatment or referral. Michael S. Miller, DO Patients presenting to urgent care with a primary complaint of edema of the lower extremities of any duration can pose a …
Read MoreBeware the BFRF!
John Shufeldt, MD, JD, MBA, FACEP Remember the scene in Ghostbusters when Gozer (the Gozarian) asks Ray Stantz if he is a “god?” Stantz, compulsively honest, says, “No.” Gozer says, “Then die,” as he tries to blow them off the roof of the building. After recovering, Peter Venkman yells at Stantz, “If someone asks if you are a god, you say YES!” The question Gozer asked Stantz was a red flag – one of those …
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An Introduction to Urgent Care Advertising
Urgent message: Unlike many other practice models, urgent care must appeal directly to the customer to stay “top of mind” and be the first option the patient considers when a need arises. Alan A. Ayers, MBA, MAcc Urgent care is a healthcare delivery channel built around the needs of consumers – “retail,” from a marketing perspective – with convenient locations, evening and weekend hours, walk-in service, the capability to treat a range of illness or …
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A Patient with Suspected Pulmonary Embolism
Urgent message: High degree of suspicion combined with thorough history and proper use of available tests can help the clinician identify patients in need of emergent referral. John Shufeldt, MD, JD, MBA, FACEP and Kelli Hickle Introduction A 47-year-old woman with a diagnosis of ovarian cancer developed an acute onset of mild shortness of breath two days after being discharged for a work-up of symptomatic ascites. Her medical history was significant for obesity and recent …
Read MoreUrgent Care Without a Paddle
Economy getting you down. Feeling like you’re up the veritable creek. Whether you’re an owner, manager, or practitioner, if you’re not feeling the heat, you should be. That’s not to say you should get out of the kitchen; just be a better chef. There has never been a crisis in history that did not create great opportunity for those who know how to find it. During a crisis of any kind, two classes of people …
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