Practice Management
Click Here to download the PDF In the macro and “dot phrase” era, there are many refrains that appear in the electronic medical record (EMR) with such regularity that we don’t even notice them anymore. Statements like All questions were answered prior to discharge, The patient verbalizes understanding and is comfortable with the plan, and Symptomatic care and over-the-counter treatments discussed are so commonly tacked onto charts that our eyes have been trained to gloss …
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I had time to see one more patient as my shift was winding down. “Wound check. That should be a quick one,” I said to myself. Famous last words. I soon learned that the young woman with the dog bite on her hand was returning for her fourth visit in as many days for the same issue. She sat fidgeting on the exam table and was visibly irritated when I walked in the room. “It’s …
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Joshua Russell, MD, MSc, FCUCM, FACEP I didn’t want to send her to the ER, but what else could I do? Mrs. C was a gaunt 72-year-old Chinese-American woman who had never been to our clinic before. Her son carried her in at 7:56 pm like a bride across the threshold. “She cannot walk,” he said, startling the MA sitting at the front desk. “Has she been seen here before?” our MA asked …
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Joshua Russell, MD, MSc, FCUCM, FACEP I’m just going say it: we should repeat vital signs more often in urgent care. But from the odd looks I get whenever I work with a new medical assistant, I realize that asking for vitals to be rechecked isn’t common practice among my colleagues; it may even be frankly contrarian. So, before I lose you, I’ll concede that one set of vital signs is more than enough for …
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Joshua Russell, MD, MSc, FCUCM, FACEP Recently, a PA I supervise called me about a young woman who came in for hematemesis and melena at home. The provider, let’s call him Tom, told me that the patient had normal vital signs, but he thought she should still go to the ED. I could sense some reluctance in his voice though. It was probably because the patient was just 32 years old and looked well. Understandably, …
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I don’t know about you, but I’m tired of being talked at about antibiotic stewardship. We all realize it’s a problem. And though it’s common practice to blame urgent care providers for the situation, we aren’t uniquely culpable for antibiotic overuse. To anyone paying attention, it’s clear that antibiotic overprescribing in urgent care remains as rampant as crime in Gotham City. And the topic has become exhausting for UC providers, not because we believe it …
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I got my first guitar when I was 14. It was an Alvarez acoustic with an electric pick-up, and I played it every day—at least for a while. I thought it would make me cool and make the girls take notice. But after about a year, when neither of those things had happened, I just about gave up the guitar for good. There simply wasn’t much joy in always playing alone. What revived and has …
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In the world of urgent care, it’s assumed that we exist to provide immediate, episodic care for discrete problems. The sore throat, sprained ankle, and laceration are our bread and butter. However, we do not practice in a vacuum. We share patients with other clinicians who longitudinally follow and manage their multiple comorbidities. Additionally, for the growing number of patients without a primary care provider, we commonly serve as the sole point of contact with …
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Patient volume has always been a delicate topic between the clinical staff and administrators of urgent care centers. It’s no secret who stands where in this ongoing debate. Regardless of each side’s opinions, UC volume has been largely stochastic historically, fluctuating at its own whim without regard for who wishes it were higher or lower. Things are different now, though. Thanks to COVID, UC overcrowding has become the new ED overcrowding—ubiquitous. The large volumes of …
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Joshua Russell, MD, MSc, FCUCM, FACEP A colleague, Dr. Mitchell we’ll call him, told me about a PA that he was supervising recently who made a great catch in a patient with a swollen, blue finger: Achenbach syndrome. When the PA presented the presumptive diagnosis, Dr. Mitchell, unfamiliar with the condition, had to Google it before seeing the patient. Our PA was right, though. The patient walked out of clinic, happy to have a benign …
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