Clinical

Case A 35-year-old, HIV-infected patient who recently started highly active antiretroviral therapy (HAART) presents to your urgent care center very concerned about a large group of vesicles that had appeared on her leg. She recalls feeling a burning sensation for several days before they appeared. Upon probing, she tells you that she’s also had headache, neck pain, and fatigue. View the photo and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.Read More

Case The patient is a 74-year-old man who complains of epigastric pain. He is an alcoholic who has had multiple episodes of pancreatitis. He has no chest pain, shortness of breath, or diaphoresis. An ECG is performed by staff prior to provider evaluation. Upon exam, you find: General: Alert and oriented Lungs: CTAB Cardiovascular: RRR without murmur, rub, or gallop, occasional irregular beats Abdomen: Soft and NT without r/r/g View the ECG taken and consider what the diagnosis and next steps would be. Resolution of the case id described onRead More

Case A 51-year-old woman presents with wrist pain and swelling after tripping on a loose piece of carpeting and falling on her outstretched hand. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. Figure 1.  Read More

We’ve all heard it: Why do we have to change? This is the way we’ve always done things! Change is difficult, even for those of us who embrace it. But it is especially difficult for non-owner employees. After all, why welcome the discomfort and uncertainty of change if there is no upside to your personal bottom line? This is perhaps one of the biggest challenges we face as the urgent care industry matures and competition for a finite number of patients increases. If we don’t differentiate, we die. But gettingRead More

Nihar B. Gala, MD Urgent message: The ability to distinguish between urgent and truly emergent conditions is an essential skill for all urgent care providers. That distinction is especially challenging when symptoms could indicate either a relatively benign diagnosis that is well within the purview of the urgent care setting or a more dire diagnosis better suited for a higher-acuity setting. Introduction “Familiar” symptoms such as vomiting, diarrhea, and abdominal pain could be due to a mild viral infection—or, as in this case, a potentially life-threatening emergency. The key toRead More

Tracey Quail Davidoff, MD  Urgent message: Tattoos and piercings are becoming commonplace, but patients who experience complications with these forms of body art may present to urgent care centers, as access to dermatology and plastics specialists frequently requires a referral or extended wait periods. The urgent care provider should possess a working knowledge about how tattoos and piercings are performed, how to recognize the complications, and how to treat them appropriately.  TATTOOS Introduction The term tattoo is derived from the Tahitian word tattau, which translates “to mark.”1 Tattoos occur whenRead More

Employing an organizational psychologist or paying for expensive employee screening services is simply not in the cards for most urgent care centers. Yet, hiring “right” is perhaps the most important thing we do and the implications on our practices are considerable. Here are just a few of the areas most impacted by our talent acquisition success (or failure): Risk, quality, and liability Patient satisfaction Operations and work flow Culture Now let’s look a little more deeply at each. Risk, quality and liability: This is our core covenant with patients. WeRead More

The patient is a 43-year-old man who presents to urgent care with widespread skin petechia and palpable purpura on his legs. He reports these symptoms occurred around 2 weeks after he recovered from an upper respiratory tract infection. In addition, he’s experienced fever, diarrhea, and vomiting. He mentions pain in his scrotum, as well. View the photo (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. Figure 1.Read More