Case A 67-year-old man presents with constipation and abdominal pain that has been present for the last 2 days. 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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Early Flu Deaths May Stoke Vaccinations
As reports of deaths due to seasonal flu start to trickle in—eg, Iowa and California just announced their first flu-related fatalities of the season—patients on the fence about getting vaccinated may be moved to head to the urgent care center for a shot. Not coincidentally, some clinics are already expanding their hours to meet what is expected to be increased demand. The Centers for Disease Control and Prevention views the flu “season” as lasting from …
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An Urgent Care Approach to Burns
Urgent message: Burn injuries present with varying degrees of involvement and severity. It is vital that providers in an urgent care facility understand burn classification, treatments, and, most important, which burn patients can be treated in an outpatient setting and which patients require a higher level of care. DREW LONG, BS, BRIT LONG, MD, and ALEX KOYFMAN, MD Introduction Burn injuries are often devastating and are a leading cause of accidental injury and trauma in …
Read MoreAbstracts in Urgent Care: November, 2015
Hypertonic Saline in Bronchiolitis Key point: Consider using hypertonic saline for bronchiolitis.Citation: Zhang L, Mendoza-Sassi RA, Klassen TP, Wainwright C. Nebulized hypertonic saline for acute bronchiolitis: a systematic review. Pediatrics. 2015;136:687–701. Bronchiolitis continues to be difficult to treat despite its high prevalence. With the exception of nasal bulb suction, few techniques have shown significant benefit, to the frustration of both patients’ parents and health-care providers. A Cochrane Review suggested that hypertonic saline (HS) may benefit …
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Palatine Mass: Physiologic or Pathologic?
Urgent message: Urgent care physicians often encounter patients with masses in the mouth. If they are aware of the existence of toripalatinus and know how to treat them, they can reassure patients who may mistake this benign, congenital bony growth for cancer. JOSHUA WILSON, MS3, and SHAILENDRA SAXENA, MD, PhD Introduction Urgent care and primary-care physicians often must evaluate masses within the mouth. These masses commonly originate from the submandibular or sublingual gland, but a …
Read MoreClinical Challenge: November, 2015
Case A 56-year-old woman presents to an urgent care center with severe ankle pain after stepping off a curb. The physician obtains a radiograph of her ankle. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
Read MoreRediscovering Your Service Mission
It comes as no surprise to anyone that health care is broken. Too many interest groups, too much regulation, too many poorly aligned incentives, too many unrealistic expectations, and too many myopic solutions. Worse, the physician voice has been weakened and handicapped by a combination of our patient-first mission and by the distraction inherent in a profoundly complicated professional discipline. Think of it this way: If your primary mission was profit and the financial engineering …
Read MoreClinical Challenge 2: October, 2015
Case A 17-year-old presents with hard, painless masses on the shin. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
Read MoreAbstracts in Urgent Care: October, 2015
SEAN M. McNEELEY, MD Differentiate Bacterial from Viral to Decrease Unneeded Antibiotic Prescriptions Key point: The overprescribing of antibiotics is still an issue. Citation: Jones BE, Sauer B, Jones MM, et al. Variation in outpatient antibiotic prescribing for acute respiratory infections in the veteran population: a cross-sectional study. Ann Intern Med. 2015;163:73–80. Concerns over the amount of antibiotic prescriptions continues. (See also “Delayed Prescribing of Antibiotics for Respiratory Tract Infections” in our September 2015 issue: http://www.jucm. …
Read MoreValue-Based Reimbursement Is Premature, But That Won’t Stop It
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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