Practice Management
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 …
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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 MoreCAP Treatment Recommendations: Guided in the Right Direction Key point: Results of two large cohort studies indicate that adherence to guidelines for treating community-acquired pneumonia is a good thing. Citations: Arnold FW, LaJoie S, Brock GN, et al. Improving outcomes in elderly patients with community-acquired pneumonia by adhering to national guidelines: Community-Acquired Pneumonia Organization International Cohort Study results. Arch InternMed. 2009;169:1515-1524. McCabe C, Kirchner C, Zhang H, et al. Guideline-concordant therapy and reduced mortality and …
Read MoreThe patient is a 16-year-old male who presents with difficulty breathing and pain in his throat, along with difficulty swallowing and pleuritic chest pain. All the symptoms began “a couple of hours” prior to presentation. There is no history of trauma or choking, nor of a recent dental procedure. On exam, the patient looks well, and is quiet and not toxic; there are no sign of distress. Pulse is 75, O2sat 94 and there is …
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Urgent message: Assessment of patients presenting with psychiatric conditions requires amodified set of skills compared with traditional medical assessment. Urgent care clinicians must be prepared to determine appropriate interventions—treatment, referral, or both. Gregory P. Brown, MD Introduction Typically, the interaction between clinicians and patients presenting with psychiatric conditions is guided by information obtained from the interview, history, and physical examination rather than emphasizing laboratory or radiological testing. Therapeutic options may be challenged by a lack …
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