Journal of Urgent Care Medicine

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 …

Clinical 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.

Rediscovering 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 …

Clinical 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.

Eighteen-Year-Old with Cough and Yellow Sputum

An 18-year-old young woman without a significant past medical history presents after 4 days of a cough productive of yellow sputum. Her mother states that her daughter has felt warm to the touch, but she has not checked her temperature with a thermometer. View the radiograph obtained (Figure 1) and consider what your diagnosis would be.

Abstracts 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. …

Value-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 …

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 …

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, …

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 …

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