How Much Time with the Physician is “Enough” Time? Key point: Length of time with a provider may not be related to patient experience. Citation: Elmore N, Burt J, Abel G, et al. Investigating the relationship between consultation length and patient experience: a cross-sectional study in primary care. Br J Gen Pract. 2016;66(653):e896-e903. This study documented the length of stay for 529 patients who were seen by a primary care physician. Patients were then asked to fill out a survey about …
Read MoreHow to Avoid Burnout? The Answer Is in the Exam Room
Much has been written of late regarding physician burnout. And why not? The rates of burnout are astronomical and the consequences are scary. Consider these statistics: Medscape Physician Lifestyle Report 2015 notes that almost half of physicians report experiencing burnout. The Physicians Foundation’s 2014 Survey of America’s Physicians reveals that physicians are far more likely to burn out than professionals in any other line of work, and that only 40% of physicians over 46 years …
Read More
A Pregnant Woman with Skin Lesions
A 30-year-old woman in her second trimester of pregnancy complained of multiple skin lesions that occurred in wheal patterns whenever she pressed firmly on her skin. Sometimes her skin would itch, causing her to apply pressure or rub and produce the wheal. Upon exam, the doctor could see a linear configuration on her arms from scratching and geometric configurations on her back, produced by her clothing View the image taken (Figure 1) and consider what …
Read More
Fever, Conjunctival Injection, and a Facial Papule
Case A mother brings her 10-year-old son to an urgent care center with a fever, conjunctival injection, and pharyngitis. She points out a smooth papule on his face that developed over the last few days. She says that he played with some kittens at a friend’s house about a week earlier, and she wonders if maybe he is extremely allergic to cats, because he has been rubbing his eyes ever since. View the image taken …
Read More
Hip Pain in an 80-Year-Old Woman
Case An 80-year-old woman presents to an urgent care center with left hip pain that she has had for 4 years but that has worsened in the last week. She reports that before the pain worsened, she had gone on a long walk with her grandson. The pain is worse with movement through the range of motion. She has taken ibuprofen, but it did not reduce her pain. She says that she has not had …
Read MoreAbstracts in Urgent Care – December 2016
Sean M. McNeeley, MD Azithromycin May Not Be Helpful for Asthma Key point: There is no proven benefit from taking azithromycin for asthma. Citation: Johnston SL, Szigeti M, Cross M, et al; AZALEA Trial Team. Azithromycin for acute exacerbations of asthma: the AZALEA randomized clinical trial. JAMA Intern Med. 2016;176:1630–1637. The randomized, double-blind, placebo-controlled trial reported here focused on treatment for 3 days for 199 adults with asthma exacerbations. One group received 500 mg of …
Read More
Original Research: HIV Screening in the Urgent Care Setting
Urgent message: Increasingly, Americans do not know their human immunodeficiency virus (HIV) serostatus. Implementing rapid HIV testing can allow your center to play a key role in identifying new cases of HIV and linking patients to care. Abstract Background: Data from the Centers for Disease Control and Prevention (CDC) suggest that an increasing number of Americans do not know their human immunodeficiency virus (HIV) serostatus. The CDC recommends routine screening for all patients 13 to …
Read More
A 14-Year-Old with Vomiting and Bumps on the Tongue
In Bouncebacks, which appears periodically in JUCM, we provide the documentation of an actual patient encounter, discuss patient safety and risk-management principles, and then reveal the patient’s bounceback diagnosis. This case is from the book Bouncebacks! Pediatrics, by Michael B. Weinstock, Kevin M. Klauer, Madeline Matar Joseph, and Gregory L. Henry, and is available at www.anadem.com and www.amazon.com. Can you spot the red flags without knowing the outcome? Introduction Note: The following is the actual …
Read More
Urgent Evaluation of Traumatic Neck Pain
Urgent message: Clinicians must be able to determine the cause and severity of injury in patients with neck pain, especially in the very young, whose symptoms vary according to their developmental status, and in the elderly, who have weaker bones and degenerative changes. Introduction Avariety of patients from children to the elderly will present to an urgent care Center with the chief symptom of neck pain. Cervical spine (C-spine) injuries occur in 3.7% of adults …
Read MoreBubble, Bubble, Toil and Trouble?
Blowing bubbles is fun. As a kid, I marveled at the almost magical way bubbles rose through the air, powered by a mere puff from my lungs, on a seemingly endless journey upward. And then they popped, unable to withstand the laws of nature. Market bubbles behave similarly, rising with indifference to the laws of nature. And much like their soapy namesakes, market bubbles always pop, with the remnants of their inflated selves crashing down …
Read More