No Troponin, No Problem: Reimagining Chest Pain Assessment in Urgent Care

No Troponin, No Problem: Reimagining Chest Pain Assessment in Urgent Care

Most urgent care providers loathe when a patient checks in with chest pain because, typically, they are presenting because they’re worried about a heart attack, and we’re worried we don’t have the tools to exclude this diagnosis. It’s no surprise that we’re met with consternation when we suggest they may have come to the wrong place for care. But is unavailability of troponin testing a worthy scapegoat? And is the practice of ED referral for …

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Our Readers Write—and Have a Lot to Say About ‘Toxic Positivity’

Our Readers Write—and Have a Lot to Say About ‘Toxic Positivity’

The January 2022 issue of JUCM led off with an editorial by Editor-in-Chief Joshua W. Russell, MD, MSc, FCUCM, FACEP about what he called “actually the epidemic that is decimating the healthcare workforce” and “a silent killer of healthcare careers.” He was referring to toxic positivity, or the practice of “encouraging” someone—in this case healthcare providers in the midst of the COVID-19 pandemic—to find and focus on the bright side rather than dwell on withering …

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Once You’re in Court, Your Documentation May Be All That Can Save You

Once You’re in Court, Your Documentation May Be All That Can Save You

Sal D’Allura, DO, FAAFP “It’s lonely being the defendant in a medical malpractice case.” Truer words were never spoken. At some point in our careers, the majority of us will be named in a medical negligence case. The unfortunate reality is that medicolegal issues will arise as a part of our professional lives along with a multitude of negative emotions (which inevitably spill over into our personal lives) when we stand accused. These negative feelings, …

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COVID-19: New Zealand’s Urgent Care Story

COVID-19: New Zealand’s Urgent Care Story

Stephen L. Adams, MBChB, FRNZCUC Like the rest of the world, New Zealand (and more particularly its healthcare system) has been changed, perhaps irrevocably, by COVID-19. Despite a relatively small direct effect on the population (0.06% infected, half of which were identified and isolated at border) with 0.0004% deaths1 (including one physician), the effects on primary care have been substantial. THE BEGINNING New Zealand clinicians were first notified of the Wuhan cluster in January 2020. …

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Counterpoint: Readers React to JUCM Original Research

Counterpoint: Readers React to JUCM Original Research

Andrew Grock, MD; Manuel Celedon, MD; and Jonie Hsiao, MD ​​It was with great interest that we read Most Clinicians Are Still Not Comfortable Sending Chest Pain Patients Home with a Very Low Risk of 30-day Major Adverse Cardiac Event (MACE) by Dr. Michael Weinstock, et al in the February 2021 issue of JUCM.1 In this study, the authors surveyed attendants at an emergency medicine conference in 2018 as to their comfort level discharging patients …

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An Ominous Trend For Urgent Care

An Ominous Trend For Urgent Care

To My Colleagues: I am writing to alert you to an ominous and pernicious trend in our industry that we must collectively address or we will face marginalization or even extinction in the years ahead. This may sound alarmist, but please hear me out. I opened my first clinic in 1987 when “urgent care” was barely a recognized term. I was there when the Urgent Care Association (at that time known as the Urgent Care …

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Why is the Waiting Room Still Empty? Perspectives from a Pediatric Urgent Care Physician

In February 2020, the first U.S. case of community spread COVID-19 was identified at a pediatric urgent care center in Seattle, reinforcing the fact that UC is on the frontlines of healthcare. Between March and May 2020, the majority of healthcare services saw a significant downturn in volumes as patients quarantined and businesses shutdown. But as the number of domestic COVID-19 cases increased, many general urgent care centers saw unprecedented volume surges that continued throughout …

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Pitfalls of Point of Care Ultrasound (POCUS)—A Perspective

Pitfalls of Point of Care Ultrasound (POCUS)—A Perspective

Urgent message: Point-of-care ultrasound (POCUS) is well established as an imaging tool in the urgent care center. Although it is generally considered safe and easy to use, safety and hygiene considerations are frequently ignored—possibly leaving patients at risk for infection and excessive radiation exposure. Avijit Barai MBBS, MRCS, MSc, PgCertCPU, FRNZCUC; Martin Necas, MMedSonography, AMS, RDMS, MRT, RVT; and Bruce Lambie, MBBS, FACEM INTRODUCTION Point-of-care ultrasound (POCUS) is well established as an imaging tool in …

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