Practice Management
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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The patient is a 46-year-old male with a history of hypertension and congestive heart failure who presents complaining of his defibrillator firing—twice yesterday and once today. He denies chest pain, shortness of breath, fever, nausea or vomiting. He ran out of his carvedilol about 1 month ago. View the initial ECG and consider what your diagnosis and next steps would be.
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Urgent message: The differential diagnosis for unilateral testicular pain includes testicular torsion; this is a ”must not miss” diagnosis, as delayed diagnosis can cause significant morbidity both physically and psychologically. Jeannette Vaughn-Dotterer, PA-C CASE PRESENTATION ML is a 47-year-old male who developed left-sided testicular pain after getting out of bed 2 hours prior. He states that his left testicle appears to be “dancing” and seems to be riding higher than his right testicle. ML states …
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Urgent message: Urgent care’s workforce has changed from primarily emergency physicians to physician assistants and nurse practitioners now making up the bulk of providers. Whereas physicians historically have been excluded from joining a union, recent efforts to organize PAs and NPs have garnered media attention. While just over 10% of U.S. employees belonged to a union in 2019, a number of groups in industries that do not traditionally have a union presence have gone on …
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Urgent message: Over the past 15 years, the nation’s largest food, drug, and mass retailers have announced clinic initiatives with great fanfare. However, we’ve heard little as these initiatives have quietly retreated and re-trenched, coincidently during the same period that urgent care has boomed. Alan Ayers, MBA, MAcc is Senior Editor, Practice Management of The Journal of Urgent Care Medicine Retail clinics—does anyone care anymore? Given there’s not been an “industry” update tallying the number of …
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KEY QUESTIONS What diagnosis explains the widened QRS? What are the electrocardiographic criteria for making this diagnosis? What rule(s) can help diagnose acute myocardial infarction with an ECG like this?
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The patient is a 30-year-old male who presents with 2 days of difficulty swallowing and what he calls a painful “bump” on the right side of his neck. View the images taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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A common question that I receive is whether COVID-19 testing is still being covered by insurance plans. The Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security Act (CARES) require insurance plans to cover diagnostic testing without cost-sharing (cost-sharing being the amount assigned to patient responsibility; it includes deductibles, copays, and co-insurance). The word “diagnostic” is significant. COVID-19 testing falls into two categories: Diagnostic – used for treatment. Patients are …
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Urgent message: Concern over the potential spread of COVID-19 may (or may not) have affected the timeliness with which parents chose to present with children who had symptoms concerning for acute otitis media, thereby throwing the concept of “delayed” antibiotic prescribing into question. Emily J. Montgomery, MD; Brian R. Lee, PhD, MPH; Amanda Montalbano, MD, MPH; Amanda Nedved, MD Citation: Montgomery RJ, Lee BR, Montalbano A, Nedved A. Time to presentation for acute otitis media …
Read MoreChamber Abnormalities: Pathologic or Not? A 27-year-old male with no reported medical history presents with chest pain. He relays several weeks of intermittent symptoms which started after lifting heavy boxes. The pain is sharp, located in the mid-chest and is otherwise non-tearing, non-pleuritic, non-positional and not associated with exertion. On examination, the patient is in no acute distress, and appears lean without cachexia or wasting. The pain is reproduced with shoulder extension. It resolves with …
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