The patient is a 25-year-old male who presented to urgent care after falling from a height of two sto- ries, landing flat on his feet. He is able to ambulate, though only with pain. In addition, he complains of back pain. He is generally healthy, and no neurological deficit was found. View the x-ray taken (Figure 1) and consider what your next steps would be. Resolution of the case is described on the next page.
Read MoreHow to Use the Level 1 Established Patient E/M Code (99211)
DAVID STERN, MD (Practice Velocity) Q.What is the code 99211? A.The official description is as follows: “Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, five minutes are spent performing or supervising these services.” This is a low-level Evaluation and Management (E/M) service. The code requires a face-to-face patient encounter with a staff member …
Read MoreAnatomy of an Occupational Health Sales Call
FRANK H. LEONE, MBA, MPH “Tell ’em what you’re going to tell ’em, tell ’em, and tell ’em what you told ’em.” —Mark Twain Urgent care clinic operators would be well advised to keep in mind Mark Twain’s advice on how to approach a speech or a paper; the same sequence applies to an occupational medicine sales call. In Phase I, it is best to articulate a clear objective for your sales call and provide …
Read MoreSettling the Case
JOHN SHUFELDT, MD, JD, MBA, FACEP The deposition is over. Your counsel tells you that, despite your barely concealed disdain for the opposing counsel, you managed to hold your own and not say anything from which you can’t recover. Unfortunately, you had to burn your dark blue suit both for the bad memories associated with it and because you are not sure if even dry cleaning it would help. Nevertheless, you are feeling pretty good! …
Read MoreAbstracts in Urgent Care: April, 2007
Computed Tomography Coronary Angiography for Rapid Disposition of Low- risk Emergency Department Patients with Chest Pain Syndromes Citation: Hollander JE, Litt HI, Chase M, et al. Acad Emerg Med. 2007;14(2):112-116. URL: http://www.aemj.org/cgi/content/abstract/14/2/112 Key point: CT coronary angiography may safely allow rapid dis- charge of patients with negative studies. Patients with recent normal cardiac catheterization are at low risk for complications of ischemic chest pain. Computed tomography coronary angiography has high correlation with cardiac catheterization for …
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A 55-Year-Old Woman with Abdominal Pain
Urgent message: Noting ‘red flags’ specific to the individual patient is of key importance when details of the presentation do not add up. Jill Chavinson Miller, MD J.W. is a 55-year-old female non-smoker who presented with abdominal pain. She reported that the pain woke her up the night before and lasted all day long, which prevented her from doing much that day. She described the pain as constant and gnawing, assessing its severity as 6 …
Read MoreA 45-Year-Old Man with Cough and Sore Throat: A Two-Step Approach to Avoiding a Bounceback
Urgent message: The clinician must address unexpected findings with further questions or testing. Michael B. Weinstock, MD and Ryan Longstreth, MD, FACEP This is the first article in a series that will appear every other month in JUCM, in which we will recount scenarios of actual patients who presented to an emergency department or urgent care facility, were evaluated and discharged, and then “bounced back.” Each of these cases is detailed in the book Bouncebacks! …
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An Approach to Care of Injured Workers
Urgent message: Appropriate treatment of workplace injuries and illnesses minimizes long-term disability while promoting rapid return to work and safer work environments. David M. Rosenberg, MD, MPH Physicians rendering care to injured workers must be knowledgeable regarding these injuries and the necessary types of treatment. Also, they must provide this care in an empathetic and caring manner, coupled with aggressive intervention to promote prompt healing. However, physicians must also realize that early return to work …
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The Dizzy Patient in the Urgent Care Setting
Urgent message: “Dizziness” can prove to be one of the more vexing complaints encountered in urgent care. To provide appropriate care, the clinician must understand whether the patient is experiencing near-syncope, disequilibrium, ill-defined light-headedness, or vertigo. Martin Samuels, MD, DSc (hon), FAAN, MACP The problem of dizziness can be one of the most exasperating in the practice of medicine. Physicians all know that sinking feeling elicited by the patient who sits down and, when one …
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