Evaluating Chest Pain in Urgent Care— “Catch 22 and the Three Bears”: Part 2

Lee A. Resnick, MD, FAAFP In my last column, I introduced a framework for evaluating chest pain in urgent care. In this month’s column I discuss a risk and probability stratification that can assist in disposition decision-making. The following discussion considers existing evidence, but there is no formal guideline for this process in the outpatient setting. Our goal is to make a risky scenario into something we can live with. This model is for risk-stratification …

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Evaluating Chest Pain in Urgent Care— “Catch 22 and the Three Bears”: Part 1

Lee A. Resnick, MD, FAAFP What can Joseph Heller and Goldilocks teach us about managing no-win situations in urgent care? As it turns out, if you look under the covers of Baby Bear’s bed, you might find something meaningful, perhaps even something that’s “just right.” Take the classic no-win situation when patients present to urgent care with chest pain. Without a definitive and reliable test to guide our decision making, we are stuck with the …

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The ‘Control’ Paradox

Lee A. Resnick, MD, FAAFP Influenza is off to a fast start this year and volumes are ballooning. ‘Tis the season to be swamped in urgent care, and without a good approach, urgent care clinicians can quickly become overwhelmed, burned out, and irritable. Pile on the stress of the holidays and the demands of family and loved ones and you’ve got a recipe for disaster. Work-life balance is important for all of us, yet feels …

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The Role of Urgent Care in Reducing Hospital Readmissions

Lee A. Resnick, MD, FAAFP Early outpatient follow-up after hospital admission has been documented to be an important factor in reducing hospital readmission rates. Readmissions are also well known to cost billions of dollars annually. The problem with readmissions spans all socioeconomic classes and impacts all payors, public and private. As of 2013, the CMS began penalizing hospitals for readmissions, thus efforts are being made to limit these rates as much as possible. Numerous studies …

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A Rational Approach to ‘Suspected’ Ebola Virus Disease in Urgent Care

Lee A. Resnick, MD, FAAFP Fear and anxiety are high in the wake of the first Ebola Virus Disease (EVD) cases on American soil. As with any new, deadly, and transmissible infectious disease, confusion and missteps rule the day. The U.S. public health and disease control entities are certainly not perfect, but the reasonable clinician will see that the ability of these entities to prevent an outbreak is actually quite high. The Disease EVD causes …

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The Power of Innocence in Medicine

Lee A. Resnick, MD, FAAFP Medicine, from time to time, calls for reflection. The hangover from arduous shifts, the mind-numbing regulatory “whack-a-mole,” the technology treadmill and the career second-guessing, all contribute to an epidemic of lost perspective in our profession. In an effort to manage an avalanche of competing interests, physicians often sacrifice themselves to the point of burnout and self-destructive behavior. Without perspective, these burdens soon overwhelm even the hardiest among us. We become …

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Security Risk Assessment: Protecting Patients and Practice

Securing protected health information (PHI) is a goal we all share. Collectively, however, we are relatively clueless about how to achieve this, largely because of the massive amount of technology that almost all of us have adopted. A simple understanding begins with the most basic categorization of the technology that we use to store, transfer, and manage PHI: Software and hardware. Hardware includes all devices (desktops, laptops, routers, EKGs, and mobile devices) that store or …

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Are we all ‘criminals’?

Show of hands…how many of you consider yourselves “compliant” with the array of regulations, laws and so-called “guidelines” you work under? Most of the time? Some of the time? Never? Now, let me pose the question a different way: How many of you think you can always, or even most of the time, remain in compliance and have a successful practice? Or, consider the question presented this way: How many of you think you can …

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Risk Mitigation in Urgent Care: Part 3

Lee A. Resnick, MD, FAAFP In my previous column, I discussed three core areas where risk and potential liability exposure lurk and ways to mitigate that risk. This month, the last in the three-part series, I will focus on specific clinical policies and procedures that can effectively reduce liability risk and enhance patient safety, quality and patient satisfaction…the holy grail of high-performing practices. Eliminating ‘Pre-triage’ The term “pre-triage” is used to describe the all-too-common practice …

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