Practice Management
Second in a Two-part Series Urgent message: Acute injuries to the midfoot and hind foot require immediate treatment or emergent referral. Close attention to the location and mechanism of injury at the urgent care site may facilitate efficient care and prevent long-term disability. Phillip H. Disraeli MD, FAAFP In keeping with the tone of part 1 of this two-part series (JUCM, December 2008), this article will discuss the urgent care clinician’s approach to foot fractures …
Read MoreMuch has been written lately on the growing crisis in emergency services: diversions, overcrowding, uncompensated care, lack of hospital beds, and the high cost of care in emergency department settings. Much has also been written of late about the growing crisis in primary care: poor reimbursement, declining numbers of primary care physicians and trainees, and declining access to primary care as a result. This has caused increased wait times and limited same-day availability. All of …
Read MoreThe patient is a 35-year-old female who got her finger caught in a metal staircase banister one day prior to presentation. Physical examination is significant for R 5th finger PIP hyperextension and DIP hyperflexion (swan neck deformity). Her PIP flexion limited to about 20°, while her contralateral PIP joint shows about 100 degrees of flexion. No sensory or motor deficits noted. View the x-rays taken (Figure 1 and 2) and consider what your diagnosis and …
Read More
In primary care medicine, patients’ symptoms are approached from the “front door;” what are the most likely causes? Urgent care medicine often starts with a “back door” approach; think “worst first,” then proceed backward through the differential after excluding life threatening causes. Urgent care does not have the luxury of an established patient relationship or defined return visit we often have only one chance to get it right! The differential for an urgent care patient …
Read More
Urgent message: Acute injuries to the foot often send patients to an urgent care center—though on occasion they don’t present for weeks, or even months, after the injury occurred. Understanding the natural history of untreated fractures in the foot is imperative to positive outcomes. The first in a two-part series. Phillip H. Disraeli MD, FAAFP This article will focus primarily on two aspects of care: 1. Proper management of and follow-up for simple nondisplaced fractures …
Read MoreI expected a firm retort from our colleagues in academic and traditional family medicine with regard to my column Is Urgent Care “Real” Family Medicine? (JUCM, October 2008). Unexpectedly, however, the column brought concern from one of our urgent care colleagues with roots in emergency medicine. In his letter—excerpts from which are presented here—Dr. Bryan Dunn of Boerne/Bulverde Urgent Care in Texas writes: “Your editorial came across as a slap in the face to emergency …
Read MoreED Crowding Adversely Affects Patient Satisfaction Key point: Dissatisfaction lasts throughout entire hospital stay. Citation: Pines JM, Iyer S, Disbot M, et al. The effect of emergency department crowding on patient satisfaction for admitted patients. Acad Emerg Med. 2008;15:825-831. Recent studies on emergency department overcrowding have shown adverse patient outcomes when patients are boarded in the emergency department. To address how patient satisfaction relates to ED overcrowding, these authors retrospectively reviewed Press Ganey satisfaction surveys …
Read MoreThe patient is a 55-year-old female who experienced a blow to the back when she fell while riding a bus. She complains of pain in her neck, shoulder, and back. On examination, you find that her vitals are stable and she has no significant past medical history. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. (Hint: this …
Read MoreSan Francisco Syncope Rule: Less Sensitive Than Previously Reported Key point: An independent validation study demonstrated a sensitivity of only 74% for predicting serious outcomes. Citation: Birnbaum A, Esses D, Bijur P, et al. Failure to validate the San Francisco Syncope Rule in an independent emergency department population. Ann Emerg Med. 2008;52(2):151-159. Most patients who present with syncope have benign etiologies, but, for some, syncope is caused by a potentially life-threaten- ing condition. Differentiating between …
Read MoreThe patient is a 23-year-old male who presents with a complaint of pain in the heel area after slipping down four steps. He is limping but able to bear weight. On exam, you note local tenderness and swelling over the area of the Achilles tendon. Other findings are unremarkable. View the x-ray 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