Lee A. Resnick, MD, FAAFP Well-meaning or not, government regulation of health care is always cause for concern among practicing physicians. No other profession is exposed to the layers of oversight that physicians endure—from OSHA to HIPAA, from Stark to Anti-kickback laws, the OIG and Medicare, just to name a few. Individual health care bills pile on to create a practice environment so mired in regulation that it would paralyze health care delivery to adequately …
Read More
Using Tissue Adhesives in Urgent Care
Urgent message: Tissue adhesives are quick, painless, and result in a good cosmetic outcome, making them well-suited for use to treat wounds in urgent care. SIMON TANKSLEY, M.D. Introduction Tissue adhesives are ideal for closing simple lacerations, especially on the face of children.1-3 Such repairs are quick, painless, and do not require removal of sutures. They are also excellent for treating large skin tears in the elderly (Figure 1) and particularly useful for thin, fragile …
Read More
Perichondritis
Urgent message: With the popularity of piercing of the ear cartilage, urgent care providers need to be on the alert for perichondritis and to treat it promptly. SHAILENDRA K. SAXENA, MD, PHD, and MIKAYLA SPANGLER, PHARM D, BCPS Case Presentation A 26-year-old female presented with complaints of a swollen right pinna for 2 weeks. The swelling progressively worsened over time. In addition, she also complained of severe pain of the right pinna, with an intensity …
Read MoreClinical Challenge: October, 2013
The patient, a 16-year-old male, presented after a blow to his right hand. 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, 2013
Clinical Decision Tool Identifies Boys at Low Risk of Testicular Torsion Key point: No child with a normal testicular lie, age <11 years, and absence of nausea or vomiting had torsion. Citation: Shah MI, Chantal CA, Mendez DR. Prospective pi- lot derivation of a decision tool for children at low risk for testicular torsion. Acad Emerg Med. 2013;20(3): 271-278. To develop a clinical decision tool for identifying children at low risk for testicular torsion, investigators …
Read MoreRegional Health System Integration: Charting Your Course
Lee A. Resnick, MD, FAAFP These are indeed stormy and transformational times. While no one can seem to agree on the political path to reform, change is nonetheless happening at a rapid pace in health care. Previous efforts to manage health care costs and quality on a national scale sunk at sea (the HMOs and Managed Care Organizations of the 80s and 90s). But the current path to reform appears unstoppable to me, regardless of …
Read More
An Urgent Care Approach to Complications and Conditions of Pregnancy Part 2
Urgent message: From pregnancy confirmation to the evaluation of bleeding, urgent care centers are often the initial location for management of obstetric-related issues. Careful use of evidence-based guidelines is the key to successful outcomes. DAVID N. JACKSON, MD, FACOG and PETAR PLANINIC, MD, FACOG Case Presentation Urgent care providers are called upon to manage a variety of complaints in pregnancy. Some conditions can be managed at the urgent care center whereas others require stabilization and …
Read MoreClinical Challenge: September, 2013
The patient, a 76-year-old male, presented with a complaint of palpitations. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
Read More
Paraphimosis
Urgent message: Most cases of paraphimosis can be managed in the urgent care setting and prompt treatment is necessary to avoid complications. MOHAMED A. FAYED, MD Overview An uncircumcised male’s penis consists of the penile shaft and glans penis covered by foreskin. At birth, the foreskin and glans penis are fused, which is called physiologic phimosis. Approximately half of uncircumcised males have fully retractable foreskins by age 10 years; by age 17, the foreskins of …
Read MoreWhat’s In a Test? The Psychology of Patient Expectations
Lee A. Resnick, MD, FAAFP The impact of patient expectations and pressures on high utilization rates in this country is a subject of significant discussion but surprisingly little study. A literature review produces scant evidence of scientific inquiry in this area. And yet, most clinicians would say that patient expectations are perhaps an even stronger motivation for utilization than fear of malpractice suits. In an ever-competitive, service- oriented industry like urgent care, this can only …
Read More