03/18/2024    Keith L. Gurnick, DPM

Urgent Care Centers and Emergency Rooms: Misdiagnosis, Post-Op Shoes, and Walker Boots

I always appreciate when one of my existing
patients returns to my office for follow-up after
an accident or injury where they first sought care
at an emergency room or an urgent care facility.
However, I am finding a plethora of issues when I
see some of these patients.

Some are misdiagnosed, told they have a fracture
when they have a sprain, told they have a sprain
then they have a fracture or told they have a
cellulitis when they have gout are just three
examples. Often basic x-ray imaging is done, and
misinterpreted because the reading is done later
by an off-site radiologist.

The next issue is that too many patients show up
to my office in a post-op shoe or walker boot that
is fit improperly. Often the walker boot or shoe
is too large or too short and needs to be
discarded for a properly fitting one. Or they are
fitted for a short walker brace, when a tall
walker brace is more appropriate for proper
immobilization to treat the injury. Or they are
fitted for a walker brace for a simple 5th toe
fracture where a surgical shoe is fine and causes
less issues during healing.

Should not these facilities be held to the same
standards as a podiatrist, since they are treating
on an urgent basis, the same conditions and
injuries we treat in our offices? Shouldn't the
nurses and assistants at these facilities be
equally trained to size and properly fit and
dispense post-op shoes, walker boots and properly
sized crutches? Am I alone here or is anyone out
there seeing the same thing? Insurance companies
do not often pay twice for the same supply item
and this also creates billing and collection
issues as the bill that gets processed first, is
the one that gets paid, and the one that gets
processed second gets the denial as duplicate
supply item.

Keith L. Gurnick, DPM, Los Angeles, CA

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