Urgent Care Is the Best Place for Patients with ‘Hypertensive Urgencies’: Why We Should Stop Sending Patients with Asymptomatically High Blood Pressure to the ED

Most public health campaigns, with a few notable exceptions, have been abject failures. One undeniably successful example, however, has been awareness of the dangers of high blood pressure. As recently as the early 1970s, when the Framingham Study was published, there was still considerable disagreement in the medical community about the risks of untreated hypertension. But in the face of mounting evidence, it soon became clear that persistently elevated blood pressure was dangerous to a number of organ systems. Additionally, it was also around this time when the terms “hypertensive …
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Keep Your Differential Broad, Especially During Flu Season

I’m phenomenally bad at gambling for a multitude of reasons. I bet small when I should bet large. I bet large when I shouldn’t even be playing the game. I’m especially terrible at roulette because when I pick a number, usually 22, I stick with it—much longer than I should. Each time the wheel stops, on any other number, I’m disappointed, sure. But that disappointment is quickly replaced with hope that the odds of lucky 22 coming up next time must be better. In other words, I feel that I’m …
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A New Year, and a New Era for JUCM

35,000. As I assume the role of editor-in-chief of the journal, this is the number that revolves through my head with rhythmic pops like an old, vinyl record. Cognitive psychologists estimate that that’s the number of decisions an average adult makes every day. This number may seem impossibly large at first, to the point of absurdity even. After all, that breaks down to a decision every 2 seconds. But let’s pause briefly and examine this. Pay attention for a moment and you’ll realize that you’re constantly deciding what you ought …
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For Auld Lange Syne, Many Great Years

The year was 2006: Saddam Hussein was executed for crimes against humanity. The Wii gaming console debuted. Pluto lost its planetary status. High School Musical and Borat were the talk of the town in entertainment. And JUCM, The Journal of Urgent Care Medicine was born—the first and only peer-reviewed journal in the industry (which it remains to this day). Well, let’s just say that JUCM was the undisputed highlight of 2006! The whole idea for JUCM was given life in a small rented conference room at O’Hare Airport in Chicago …
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The MIPS Mess

It should not be terribly surprising to anyone that the massive government effort to incentivize quality has run into some serious challenges. Adjudicating quality has always been a briar patch of exceptions, confounders, red tape, and bias. To make matters worse, as with large government efforts, you end up with a whole bunch of unintended consequences that typically add cost and effort to the very practices that can handle it the least. As we all learned in high school physics, every action has an equal and opposite reaction. And the …
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