Practice Management
A 27-year-old woman who has been training for a marathon presents to the urgent care center with epigastric pain. She states the pain is worse after she consumes tomato sauce or orange juice, and wonders if she may have reflux. She denies shortness of breath, exertional component, pleuritic pain, leg swelling, use of hormonal therapy, or sweating. No right upper quadrant pain. Improves with antacids. No FH or heart disease or other risk factors. Upon …
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Case The patient is a 45-year-old male construction worker who felt pain immediately after stepping down from a truck into a pothole. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page. Figure 1.
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Urgent message: Sore throat and throat pain are common complaints in the urgent care setting. While infectious causes are the most common and the likely cause of the patient’s complaint, it is important to consider other causes. Linu Samuel, MD Introduction Sore throat and throat pain are common chief complaints across all ages in the urgent care setting. As clinicians who likely see these complaints multiple times a day, our differential diagnosis when walking into …
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The patient is a 43-year-old man who presents to urgent care after work with an extremely pruritic fine scaly plaque and tense vesicles covering his hands and arms. He had been gardening the previous weekend, worked on his car, and prepared his boat for its first voyage of the season. He wasn’t sure which activity might have caused such a terrible rash. View the image and consider what your diagnosis and next steps would be. …
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Urgent message: “Wilderness” medicine is less exotic than one would think. Patients with complaints that began during or after an outdoor outing in any season are likely to present to urgent care, making wilderness medical knowledge of paramount importance. Stewart Harsant, MMS, PA-C Introduction Every season holds its own unique appeal to those who love the great outdoors. Similarly, every season has its own distinct set of risks, ranging from gastrointestinal symptoms, dermatological conditions, …
Read MorePractice of Urgent Care: The Illusion of Multitasking and the Cost of Interruptions Key point: True multitasking is not possible. Rather, when we attempt to multitask, our brains are actually rapidly switching focus. Task-switching and interruptions negatively impact our ability to complete tasks accurately and effectively. Minimizing task-switching reduces the likelihood of cognitive errors and, consequently, adverse patient outcomes. Citation: Skaugset LM, Farrell S, Carney M, et al. Can you multitask? Evidence and limitations of …
Read MoreMitigating Risk Through Shared Decisionmaking Key point: Shared decision-making appears to mitigate the risk to clinicians of patient complaints and lawsuits in the event of a bad outcome. Citation: Schoenfeld EM, Mader S, Houghton C, et al. The effect of shared decisionmaking on patients’ likelihood of filing a complaint or lawsuit: a simulation study. Ann Emerg Med. January 3, 2019. [Epub ahead of print] Missed and delayed diagnoses of dangerous conditions are unavoidable in …
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Figure 1. Case A 10-year-old boy visited urgent care complaining of multiple skin lesions on the rim of his ear. They had begun as vesicles and some were beginning to crust. He also had enlarged cervical lymph nodes. His mother was concerned because the symptoms developed after an early spring camping trip with his scout troop and two other boys had similar symptoms. View the photo taken, and consider what your diagnosis and next steps …
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Case The patient is a 70-year-old female who presents with gradual onset of constant pain in her left lower chest and back. She is unsure when she first noticed the pain, but reports that it has worsened since she experienced a fall several days ago. She denies shortness of breath, diaphoresis, or an exertional component. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case is described …
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The patient is a 28-year-old man who presents to urgent care with a single annular ecchymosis lesion on his leg the morning after returning home from a trip to visit his family’s cabin in the mountains of North Carolina. He “thought” he noticed a small insect bite in the vicinity. The lesion has become increasingly painful. View the photo taken and consider what your diagnosis and next steps would be. Resolution of the case is …
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