Journal of Urgent Care Medicine

The Story of Jonathan— One Week in January

The Patient’s Perspective Jonathan is a young man who changed the course of musical theatre and would still be making history today if things had turned out differently. Jonathan was born in Mount Vernon, NY in 1960. When he was 22, he moved to New York City to pursue his dream of writing a musical. Like most struggling artists, life wasn’t easy. He spent weekends waiting tables at the Moondance Diner in Soho. He spent …

Appendicitis Due to Squirrel Dinner

Introduction Appendicitis due to foreign bodies is a rare occurrence; most cases reported in the literature have occurred due to sharp objects such as pins, needles, toothpicks, and small nails. Solid foreign bodies – such as a bullet – rarely cause appendicitis. Appendicitis due to traumatic gunshot wounds has been described before, as have appendicitis cases due to ingested birdshot. Here, we describe an interesting case that demonstrates the importance of eliciting a history of …

Abstracts in Urgent Care: June, 2009

Incidence of AMI in Patients with Syncope Key point: In a cohort study of nearly 1,500 patients presented without ST-segment elevation. Citation: McDermott D, Quinn JV, Murphy CE. Acute myocardial infarction in patients with syncope. CJEM. 2009; 11: 156-160. Which patients with syncope require hospital admission? To answer this question, researchers studied the incidence of acute myocardial infarction within 30 days of presentation in a cohort of 1,474 consecutive emergency department patients who presented with …

The Story of Jonathan-One Week in January

Jonathan is a young man who changed the course of musical theater and would still be making history today if things had turned out differently. Jonathan was born in Mount Vernon, NY in 1960. When he was 22, he moved to New York City to pursue his dream of writing a musical. Like most struggling artists, life wasn’t easy. He spent weekends waiting tables at the Moondance Diner in Soho. He spent weekdays at his …

Toward Ensuring Patient Safety in Urgent Care

Urgent message: Creating a safety culture in the urgent care clinic starts with proper hand washing before even seeing a patient and ends with transitioning care out of the practice – and includes close attention to every detail in between. The second of two parts. Phillip Disraeli MD, FAAFP The Institute of Medicine’s 1998 Report to Err is Human grabbed media attention by estimating that 98,000 deaths each year can be attributed to adverse events …

Of Swine Flu, ‘Chicken Little,’ and the Great Depression

History teaches us so many lessons, most of which we quickly forget until the next history-making crisis. Nothing in history is a more predictable crisis producer than “fear.” Fear sows panic, panic sows irrational behavior, and irrational behavior sows wars, economic disasters, bigotry, and protectionism. When the dust settles, we analyze our missteps and, often, recognize most of the fallout could have been avoided had we learned from history. The Great Depression was a real …

Clinical Challenge: June, 2009

The patient is a 32-year-old male who woke up at 1 a.m. with a burning sensation in the mid-chest (a first-time event, he reports). The patient is not diaphoretic, and has no dyspnea. He is generally healthy and has no known risk factors for heart disease. His physical exam is unremarkable. In addition, you find: BP: 154/102 Pulse: 68 Sat: 99% Temperature: 97.3°F View the electrocardiogram taken (Figure 1) and consider what your next steps …

Abstracts in Urgent Care – May 2009

Occult Bacteremia is Rate in Young Children with Unexplained Fever Key point: Since introduction of the pneumococcal vaccine, urinary tract infection has become the most common bacterial infection in children who have fever without localizing signs. Citation: Waddle E, Jhaveri R. Outcomes of febrile children without localizing signs after pneumococcal conjugate vaccine. Arch Dis Child. 2009; 94: 144-147. Occult bacteremia and invasive disease are important concerns in children with unexplained high fever. Investigators retrospectively compared …

Toward Ensuring Patient Safety in Urgent Care

Urgent message: As urgent care’s role in the continuum of care continues to evolve, the practitioner must take steps to create a culture that supports proper patient identification, drug safety, and adherence to lab standards. Phillip Disraeli MD, FAAFP In the 1988 report To Err is Human, the Institute of Medicine defined patient safety as “freedom from accidental injury.” The ensuing media coverage focused on the 98,000 deaths that IOM estimated occur each year due …

The Art of Conflict Management

Urgent care centers are fertile ground for angry patients. Our patients are often sick and in pain, they often have long waits to be seen, and they are frustrated by an inefficient healthcare system that has landed them in urgent care in the first place. Additionally, most of our patients are starting a new relationship with us, and they have not yet built any trust. Their prior healthcare experiences are most often lousy at best, …