The malpractice debate continues, like a rerun of Quincy, M.E. – you know the ending, but pretend to be surprised, if only to justify why you would watch the same show twice (or, in this case, many more). The issue of medical liability, while it has received little attention I the health reform debate, is perhaps the best example of why changing healthcare, no matter where you want it to go, is so difficult to …
Read MoreClinical Challenge: November, 2009
In 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 19-year-old male who complains of pain after receiving a blow to the shoulder. Range of motion is limited due to pain. The patient …
Read MoreAbstracts in Urgent Care: October, 2009
Another Validation of Clinical Assessment and D-Dimer to Rule Out PE Key point: Among patients with low or intermediate risk, the sensitivity and negative predictive value of D-dimer testing were 100%. Citation: Gupta RT, Kakarla RK, Kirshenbaum KJ, et al. D-dimers and efficacy of clinical risk estimation algorithms: Sensitivity in evaluation of acute pulmonary embolism. AJR Am J Roentgenol. 2009; 193: 425-430. Despite research showing that clinically important pulmonary embolism (PE) can be excluded when …
Read More
Preparing for Pandemic Influenza in the Urgent Care Setting
Urgent message: Between the current – and still growing – volume of H1N1 flu cases and fast-approaching influenza season, the urgent care physician will be challenged to distinguish among a variety of common cold and influenza-like conditions. Gary Klein, MD, MPH, MBA, CHS-V, FAADM Introduction The mainstream media have certainly accomplished the mission of alerting the public to the dangers of H1N1 flu – perhaps to the point that many are tempted to dismiss their …
Read MoreWhat can YOU do for YOU?
I know this may sound like a funny way to start a column. It’s a bit confrontational perhaps, maybe even a little insulting. Why is this guy calling me out on the carpet here? What did I ever do to him? I have been involved in organized medicine for almost 10 years, at varying levels of responsibility. If I learned one thing alone the way, it is this: If you want id one, you better …
Read MoreClinical Challenge: October, 2009
A 57-Year-Old Woman with Acute Pain After a Fall The aptient is a 57-year-old woman who presented to urgent care complaining of severe pain in her right foot, leg, hip, and elbow. She reported that she fell three to four hours prior to presentation while outside walking her dog; she was “tripped up” in the pet’s leash. She presented ambulatory, but was unable to bear any weight on her right leg. Past medical history …
Read MoreThe Case of a 53-Year-Old Female with Headache and Eye Pain
Headaches are both common and challenging, accounting for 4% of ED visits and comprising the eighth most-common complaint seen by primary care physicians. This frequency can create a false sense of security, as there are numerous life-threatening etiologies hiding in the “haystack.” In this month’s case, our patient was a bounceback on her first visit, having previously seen her PCP and an urgent care doctor. In addition to a brief discussion of headaches and their …
Read More
Assessing Patients in the Wake of Motor Vehicle Accidents
Urgent message: Patients presenting to urgent care in the wake of a motor vehicle accident have self-selected their treatment setting. However, it is imperative to maintain vigilance for potentially serious and even life-threatening injuries that may not be apparent. Gloria I. Kim, MD and Jill C. Miller, MD According to the National Center for Health Statistics, motor vehicle accidents (MVAs) accounted for nearly 5 million ED visits in 2006. The diverse injuries may be temporary, …
Read MoreH1N1: The Sequel
Unless you have spent the entire summer on Gilligan’s Island, I assume everyone remains attuned to the daily reports on H1N1 streaming from every which way but loose. While the prevailing opinion is that the flu season will be Superbad, it remains difficult to predict how things will play out. We will be dedicating the October issue of JUCM to pandemic flu planning, though given the likelihood of an early spike of flu, there are …
Read MoreClinical Challenge: September, 2009
A 62-year-old female presents to the urgent care center with a three-week history of a pruritic facial rash that initiated on one cheek, then spread to the rest of the face. The patient states the rash got worse after sun exposure. Initially, she self-treated with cold cream, Eucerin, and other over-the-counter moisturizers that did not help. Eventually, the patient tried a topical hydrocortisone cream that made the rash much worse. You note there is no …
Read More