Lee A. Resnick, MD, FAAFP Private payor reimbursement trends nearly always follow Medicare’s lead, and at no other time in history has the physician reimbursement model been so scrutinized. In an attempt to control unwieldly healthcare spending, payors are understandably looking to be creative. When they look at the drivers for increased health spending, one thing is clear: Diagnostic testing and imaging services grew far faster since 2000 than any other health-care service. According to …
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Managing Hypertensive Emergencies in the Urgent Care Setting
Urgent message: Health-care practitioners frequently see patients in urgent care centers who have elevated blood pressure. It is vital that they be able to identify hypertensive emergencies to immediately start lowering such patients’ blood pressure and then transfer them to an emergency department, to avoid hypertensive damage to the brain, heart, and kidneys. JON JUHASZ, MD Introduction Elevated blood pressure (BP) is very common in the urgent care setting, oftentimes from pain or from chronic …
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Mixed Martial Arts Injuries
Urgent message: Because typical participants in mixed martial arts are young and healthy, many present to urgent care settings with a clear musculoskeletal injury and no other medical problems. Do not be distracted by the most obvious injury. Injuries from atypical mechanisms of injury are common in mixed martial arts and should be considered when evaluating a patient who has sustained injuries while participating in the sport. DEENA R. ZIMMERMAN, MD, MPH, IBCLC; NAHUM KOVALSKI, …
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Fever Phobia: Urgent Fears in Urgent Care
Urgent message: Fear of fever leads many parents to seek urgent care. Addressing their fears should be part of the care of febrile children. DEENA R. ZIMMERMAN, MD, MPH, IBCLC; NAHUM KOVALSKI, MD; BARUCH HAIN, BA; and JOSHUA LIPSITZ, PHD In several studies, researchers have found that a large percentage of parents have fever phobia, or inaccurate beliefs about the harmfulness of an elevated body temperature. Those studies were conducted in primary-care settings, so we …
Read MoreClinical Challenge: October, 2015
This feature will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of 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]. Case A 12-year-old presents with severe ankle pain and swelling after twisting an ankle while jumping off a tree limb. View the image taken (Figure 1) and consider what …
Read MoreClinical Challenge: September, 2015
Case A patient presents after a fall during a soccer game, reporting severe pain in one thumb and difficulty grasping anything between the thumb and forefinger. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
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Delayed Prescribing of Antibiotics for Respiratory Tract Infections
Urgent message: Respiratory tract infections are a common complaint in the urgent care setting. Many patients present with the expectation of receiving antibiotics because they have usually done so. The rise of anti biotic-resistant infections requires that we take a close look at our prescribing habits and the need to reeducate patients on the harm of overusing antibiotics. Delayed prescribing offers a way to both satisfy patients and reduce the use of antibiotics in respiratory …
Read MoreAbstracts in Urgent Care: September, 2015
SEAN M. McNEELEY, MD Adverse Events Unlikely in Patients with Negative Findings on Cardiac Evaluation Key point: Adverse events in patients admitted with negative findings on cardiac evaluation are very infrequent. Citation: Weinstock MB, Weingart S, Orth F, et al. Risk for clinically relevant adverse cardiac events in patients with chest pain at hospital admission. JAMA Intern Med 2015;175:1207–1212. In this 5-year retrospective study of patients seen in an emergency department for symptoms potentially representing …
Read MoreClinical Challenge: September, 2015
A 41-year-old man presents with left-flank pain. His past medical history is unremarkable. An incidental finding is evident on images of the kidney, ureter, and bladder. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
Read MoreEHR Interoperability: A Bridge to Nowhere
Lee A. Resnick, MD, FAAFP In the beginning, interoperability and health information exchange (HIE) were key selling points for physicians considering adoption of and investment in electronic health records (EHRs), but today most are left feeling misled, stranded on a bridge that leads nowhere. The Healthcare Information and Management Systems Society (HIMMS) defines EHR interoperability as “the ability of different information technology systems and software applications to communicate, exchange data, and use the information that …
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