Practice Management
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 …
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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 …
Read MoreHistory 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 …
Read MoreThe 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 …
Read MoreOccult 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 …
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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 …
Read MoreUrgent 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, …
Read MoreShould the Elbow Extension Test Be Used to Rule Out Bony Injury? Key point: Full elbow extension had a negative predictive value for fracture of 98.4% in adults and 95.8% in children. Citation: Appelboam A, Reuben AD, Benger JR, et al. Elbow extension test to rule out elbow fracture: Multicentre, prospective validation and observational study of diagnostic accuracy in adults and children. BMJ. 2008; 337: a2428. The objective of this study was to determine whether …
Read MoreIn our last Bouncebacks article, we explored the difficulties that arise when the patient and doctor disagree on treatment through the case of a 28-year old pregnant patient who left against medical advice (JUCM, February 2009). In the second part of this series, we present a case which explores differences in expectations between a patient and the physicians.
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