Journal of Urgent Care Medicine

Psychiatric Manifestations of Organic Disease: Don’t Get Fooled!

Urgent message: Mistaking medical symptoms for psychiatric disease can delay care and lead to adverse outcomes. Elizabeth Yeager-Cordial, MD; Janell Ison, DO; Robert Becker, MD; Courtney Boyd, MD; and Michael Weinstock, MD Citation: Yeager-Cordial E, Ison J, Becker R, Boyd C, Weinstock M. Psychiatric manifestations of organic disease: don’t get fooled! J Urgent Care Med. 2022;16(11):11-15. CASE PRESENTATION A 23-year-old man presented with a strange complaint: visual hallucinations. He had no psychiatric history and was …

No Troponin, No Problem: Reimagining Chest Pain Assessment in Urgent Care

Most urgent care providers loathe when a patient checks in with chest pain because, typically, they are presenting because they’re worried about a heart attack, and we’re worried we don’t have the tools to exclude this diagnosis. It’s no surprise that we’re met with consternation when we suggest they may have come to the wrong place for care. But is unavailability of troponin testing a worthy scapegoat? And is the practice of ED referral for …

<strong>What Is the Acceptable Miss Rate for a Major Adverse Cardiac Event (MACE)? </strong><strong>A Follow-Up Survey After Release of the American College of Emergency Physicians (ACEP) Clinical Policy on Acute Coronary Syndromes</strong>

What Is the Acceptable Miss Rate for a Major Adverse Cardiac Event (MACE)? A Follow-Up Survey After Release of the American College of Emergency Physicians (ACEP) Clinical Policy on Acute Coronary Syndromes

Urgent message: Previously JUCM-published research revealed that even very low risk for a major adverse cardiac event left clinicians uncomfortable with discharging patients per 2018 ACEP guidelines. What can be learned from a follow-up study reflecting the updated version? Rebekah Samuels, OMS-III; Francesca Cocchiarale; Samidha Dutta, DO, PGY-3; Jarryd Rivera, MD; Amal Mattu, MD; Michael Pallaci, DO; Paul Jhun, MD, FAAEM; Jeff Riddell, MD; Cameron Berg, MD; and Michael Weinstock, MD. Citation: Samuels R, Cocchiarale …

See You in Court: Practice and Documentation Change from a Mock Trial

Urgent message: “Mock trials” are a valuable tool to help urgent care providers offer better medical care, record more appropriate documentation, and learn about medical proceedings. Michael Weinstock, MD; Kaetha Frost, DO; Heath Jolliff, DO; Amal Mattu, MD; Seth McIntire, DO; Marc Calvert, JD; Mark Kitrick, JD; and Matt Delaney, MD Citation: Weinstock M, Frost K, Jolliff H, Mattu A, McIntire S, Calvert M, Kitrick M, Delaney M. See you in court: practice and documentation …

A Legal Quandary: Poor Care…or Malpractice?

Urgent message: Failure to consider subtleties and the context in which a patient presents can lead to insufficient differential diagnoses and, therefore, mis- or missed diagnoses that leave the patient at risk for poor outcomes and the provider at risk for litigation. Michael Weinstock, MD and Charles Pilcher, MD Back pain is usually back pain, whether it’s from a muscular strain or another self-limiting, non-serious cause. But there is potential danger lurking below the surface, …

A Novel Method for Blinding Reviewers to Gender of Proceduralists for the Purposes of Gender Bias Research

Urgent message Gender bias, whether overt or subconscious, may be to blame for disparities in hiring practices, salary, and advancement in medical schools, the urgent care setting, and any healthcare workplace. Recognizing the value of gender-neutral assessment may not only “even the playing field,” but increase the likelihood of identifying the best candidates for clinical positions. Michael Pallaci, DO; Jennifer Beck-Esmay, MD; Adam R. Aluisio, MD, MSc; Michael Weinstock, MD; Allen Frye, NP; Ashley See, …

Most Clinicians Are Still Not Comfortable Sending Chest Pain Patients Home with a Very Low Risk of 30-Day Major Adverse Cardiac Event (MACE)

Michael B. Weinstock, MD; Michael Pallaci, DO; Amal Mattu, MD; Cameron Berg, MD; Paul Jhun, MD; and Jeff Riddell, MD. Urgent message: Patients who present with chest pain but tests indicate there is little risk for a major event can leave providers uncertain as to what next steps are appropriate, and raise concerns for bad outcomes and litigation. Citation: Weinstock MB, Pallaci M, Mattu A, Berg C, Jhun P, Riddell J. Most Clinicians Are Still …

A Multicenter Study of the Rate of MACE in Chest Pain Patients with a Moderate HEART Risk Score Referred from Urgent Care for an Expedited Outpatient Cardiology Evaluation

ABSTRACT Background: The HEART Score is an effective method of risk-stratifying emergency department patients with chest pain. The rate of major adverse cardiovascular events (MACE) in patients with moderate HEART score referred from an urgent care center (UC) for an expedited outpatient cardiology evaluation is unknown. Purpose: The primary outcome of this study was to examine the rate of MACE when patients with moderate HEART score were referred for expedited outpatient cardiology follow-up after evaluation …

A 41-Year-Old Woman with Multiple Complaints

Urgent message: The risk in not “doing the math” with a patient’s risk factors is obvious for that patient. However, urgent care providers and operators also run significant legal risk when patients with multiple complaints present and there’s a bad outcome—even if the most pressing complaint is impossible to discern. Michael B. Weinstock, MD; David A. Farcy, MD FAAEM, FACEP, FCCM; and Ramin Vejdani, DO [This case was adapted from a chapter in the book Bouncebacks! …

Chest X-Ray Findings Among Urgent Care Patients with COVID-19 Are not Affected by Patient Age or Gender: A Retrospective Cohort Study of 636 Ambulatory Patients

Joshua Russell, MD, MSc, FACEP MD; Ana Echenique, MD, DABR; Steven R. Daugherty, PhD; and Michael Weinstock, MD Abstract Background/Objective A prior study of patients presenting to urgent care (UC) centers with COVID-191 showed that only a small proportion of these ambulatory patients demonstrated significant pathology on chest x-ray (CXR). In this secondary analysis of 636 ambulatory patients with confirmed COVID-19 from greater New York City (NYC), our primary objective was to determine whether the …