Practice Management
Urgent message: Significant cervical spine injuries are rare in urgent care but missing one can have serious implications for patient and provider. ERICA MARSHBURN, BS, BA, and JOHN SHUFELDT, MD, JD, MBA, FACEP In this continuing series on back pain diagnostics in urgent care medicine, we urge providers to carefully consider any high-risk spinal conditions that could be presenting as simple back pain. Although many cases of back pain can be attributed to musculoligamentous injury …
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Urgent message: Diagnosing UTI in a child is challenging in the urgent care setting. Fever, abdominal or back pain, frequency or new onset of incontinence all should raise your index of suspicion. KIMBERLY GIBSON, MD Cases such as the following are common in urgent care and they present unique challenges: J.S., a 2-year-old girl, presents to an urgent care clinic on a Saturday afternoon for evaluation of low-grade fever and fussiness. Her parents have been …
Read MoreLee A. Resnick, MD, FAAFP In my last column, I explained how physician reimbursement is determined by a relatively obscure and highly politicized committee shockingly biased by a specialist representation. The so called “RUC” (Relative Value Scale Update Committee) has created a pay formula that heavily favors proceduralists at the undeniable expense of the primary care physician. This biased system of reimbursement has not only created an unbalanced pay scale amongst physicians, but has equally …
Read MoreNormalization of Vital Signs Does Not Reduce Risk for Acute Pulmonary Embolism Key point: Up to one-third of patients whose abnormal triage vital signs reverted to normal values had PE. Citation: Kline JA, Corredor DM, Hogg MM, et al. Normalization of vital signs does not reduce the probability of acute pulmonary embolism in symptomatic emergency department patients. Acad Emerg Med. 2010; 19(1): 11-17. In a prospective single-center study, researchers evaluated whether normalization of vital signs …
Read MoreIn each issue, JUCM will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of determining conditions that real urgent care patients have presented with. If you would like to submit a case for consideration, please email the relevant materials and presenting information to [email protected]. The patient, a 45-year-old man, presented with vomiting and chest pain. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the …
Read MoreThe patient, a 21-year-old female, presented with trauma to her right wrist. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
Read MoreUrgent message: The patient punctured his hand with a power screwdriver. It turned out to be the least of his problems. Frank Fannin, MD, EMT-P Introduction Hand Injuries are common and a major concern in urgent care settings as a source of potential significant disability and liability. A detailed history and focused exam are paramount to appropriate treatment and disposition. In the following case, a potentially devastating finding turns out not to be all that …
Read MoreIn each issue, JUCM will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of dermatologic conditions that real urgent care patients have presented with. If you would like to submit a case for consideration, please email the relevant materials and presenting information to [email protected] The patient, a 14-year-old male, presented with a twisted ankle and a complaint of difficulty with weight bearing. View the image taken (Figure 1) and consider what …
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Urgent message: Symptoms from stones in the ureter can mimic other conditions, making for a diagnostic dilemma in urgent care. Imaging is the key to accurate assessment and appropriate treatment. WILLIAM GLUCKMAN, DO, MBA, FACEP and KATE ABERGER, MD Ureterolithiasis, which literally translates to stones in the ureter, is sometimes referred to improperly as “kidney stones,” which are properly known as nephrolithiasis. Although stones do form within the kidney, they do not typically cause acute …
Read MoreLee A. Resnick, MD, FAAFP Perhaps you are unaware about the secretive, biased way that physician reimbursement is determined in this country. Perhaps you would be surprised to learn that the committee tasked with these determinations is composed of only 2 primary care physicians … out of 29 members! Perhaps you didn’t know that their recommendations are unregulated and largely given a rubber stamp by the Centers for Medicare & Medicaid Services (CMS). Perhaps you …
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