Practice Management
Urgent message: Understanding the body’s natural ability to heal itself – and factors that diminish that ability – is of great clinical value and can help you determine whether a wound is acute or chronic, and inform the decision to clean and dress or refer to a wound specialist. Michael S. Miller, DO, FACOS, FAPWCA, CWS and Eric Newgent, DO, MS Introduction The skin is the largest organ in the human body. In simplest terms, …
Read MoreConsequences of Increasing Copayments for Ambulatory Care Key point: Even small increases in cost-sharing were associated with fewer outpatient visits and more inpatient admissions among elders. Citation: Trivedi AN, Moloo H, Mor V. Increased ambulatory care copayments and hospitalizations among the elderly. N Engl J Med. 2010; 62: 320-328. Recently, many health plans have increased copayments for outpatient visits. Although the rationale, presumably, is to minimize unnecessary ambulatory care, the strategy could backfire if higher …
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 live to submit a case for consideration, please w-mail the relevant materials and presenting information to [email protected]. The patient is a 14-year-old boy who presents with low back pain after failing from “a high height” and landing on his feet. Exam is normal except …
Read More
What happens when our patient so badly wants to be well that they talk us out of the correct diagnosis? “I think it is my anxiety” was the mantra accepted by the physician in this case. Though diagnoses are not always clear after the initial encounter, they are not up for negotiation. Patients have a vested interest, due to denial or human nature, in believing that nothing is seriously wrong with them. It can be …
Read MoreWe all think we are great listeners. We “listen” to chief complaints, we listen to histories of present illness, we listen to heart and lung sounds. We spend the better part of the day “listening.” But are we really listening? Or are we just “hearing?” Hearing is the perception of sounds by the auditory nerves in the ear. Listening involves an attentiveness to hear with a purpose of understanding. hearing is a temporal lobe function, …
Read MoreManagement of Forearm Fractures in Adults Key point: Primary care evaluation and management of forearm fracture in adults is presented. Citation: Black WS, Becker JA. Common forearm fractures in adults. Am Fam Physician. 2009; 15: 80(10): 1096-1102. Upper extremity fractures are often evaluated by primary care physicians at the patient’s initial presentation or at follow-up after the initial presentation to urgent care or the emergency department. These fractures account for approximately 2 million visits to …
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 e-mail the relevant materials and presenting information to [email protected]. The patient is a 17-year-old male who fell and experienced a blow to the right knee. On examination, you not local swelling. The patient complains of pain …
Read More
Urgent message: The accessibility of urgent care makes it a prime venue for patients preparing for international travel and patients who may have become ill due to exposure to infectious agents while traveling overseas. Francine Olmstead, MD, FACP Whether a patient visits an urgent care center for an infection or a primary care physician for follow-up, every healthcare provider should inquire about anticipated overseas travel. In addition, if a patient is being evaluated for a …
Read More‘Round and ‘round it goes… and where it stops, nobody knows. Feeling dazed and confused by the dizzying display of legislative slight of hand? Now you see it, now you don’t! Compromise, in theory, sounds like the right thing to do when trying to balance interests. Compromise often leads to parity and equity between competing interests. However, when competing interests have unequal power, compromise tends to favor those with the most influence. I promise a …
Read MoreThe patient is a 20- year- old female who presents with pain one day after experiencing a blow to the knee during a fall. On exam, you reveal no significant findings beyond mild local tenderness. She is able to bear weight fully on both legs. 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.
Read More