Journal of Urgent Care Medicine

A 16-Week-Old Infant with Bloody Vomitus

In Bouncebacks, 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. Introduction A 16-week-old infant was brought by her parents to the emergency department (ED) of a children’s hospital. Note: The following is the actual documentation by the provider. Visit …

A 34-Year-Old Man with Left Side Pain

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 month’s case reflects the actual documentation from an urgent care visit, and the patient’s bounceback the next day to the emergency department. Can you spot the red flags without knowing the outcome? MICHAEL B. WEINSTOCK, MD, and MIZUHO SPANGLER, DO Introduction Apicture tells a thousand …

The Case of a 32-year-old Woman With Headache

When an Uncommon—Potentially Catastrophic—Diagnosis Is Masked by a Common Complaint In Bouncebacks, which appears quarterly in JUCM, we provide documentation of an actual patient encounter, discuss patient safety and risk management principles, and then reveal the patient’s “bounceback” diagnosis. This Bouncebacks case is unique in that it also went to trial, excerpts from which are also presented. This case is adapted from the Bouncebacks! Medical and Legal (Anadem Publishing) by Michael B. Weinstock, MD, and …

In Appreciation…

Lee A. Resnick, MD, FAAFP JUCM, The Journal of Urgent Care Medicine, is approaching its fifth year of publication (a feat not without reason for celebration). In an environment of tremendous financial pressures, increasing scrutiny, and decreasing ad revenues, medical publishing is confronting significant challenges. JUCMis not immune. Most casual readers remain unaware of the challenges behind the scenes. It is, perhaps, no concern of theirs. But that does not mean the efforts should go …

The Case of a 49-Year-Old Woman with Pleuritic Chest Pain

In our last Bouncebacks article, we explored the difficulties that arise when the patient and doctor disagree on treatment through the case of a 28-year old pregnant patient who left against medical advice (JUCM, February 2009). In the second part of this series, we present a case which explores differences in expectations between a patient and the physicians.

The Case of a 37-Year-Old Female with Flu-like Symptoms

In primary care medicine, patients’ symptoms are approached from the “front door;” what are the most likely causes? Urgent care medicine often starts with a “back door” approach; think “worst first,” then proceed backward through the differential after excluding life threatening causes. Urgent care does not have the luxury of an established patient relationship or defined return visit we often have only one chance to get it right! The differential for an urgent care patient …

The Case of a 24-Year-Old Man with Abdominal Pain

Our goal with the Bouncebacks series is to maximize patient safety and minimize the urgent care provider’s medico-legal exposure. As Greg Henry wrote in the forward of our Bouncebacks! book, “The smart doctor is not the one who learns from his own mistakes. The smart doctor is the one who learns from the mistakes of others.” Our case this month involves a young man with vomiting and diarrhea and abdominal pain. This typical urgent care …

Fighting the Urge to Judge

Lee A. Resnick, MD, FAAFP In a previous column, entitled “Rekindling the Doctor-Patient Relationship”, I focused on methods for developing trust with your patients. The intention of building trust is to enhance patient relationships and ensure positive patient encounters. Judgments can be a significant obstacle to that process, however. In fact, judgments are the surest way to undermine trust, and can potentially lead to delay of appropriate care or to misdiagnosis. Judgments are second only …

The Case of a 10-Year-Old Male with Eye Pain

Other than these medical errors, dyspnea and advanced age were the two most common factors associated with an unscheduled return visit. What is the incidence of bouncebacks? What is the incidence of bounceback admissions? What is the inci- dence of death in patients recently discharged from the ED? What percent of bouncebacks occur because of medical errors? How can we use this information to improve patient safety? This month, we will discuss Question IV: What …

The Case of a 17-Year-Old Male with Fever and Headache

This month, we will discuss Question III: What is the incidence of deaths in patients recently discharged from the ED? In May 2007, Sklar et al performed a very interesting study concerning deaths that occurred within seven days of ED discharge. A similar study had been done in 1994 by Kefer et al, looking at medical examiner cases. Sklar’s study, however, is more likely to have captured all unanticipated deaths because it was performed at …