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Fam Pract Manag. 2013 Mar-Apr;20(2):33.

Making kids' ear exams less stressful

Editor's note: A Practice Pearl from 2011 on whistling to distract children during ear exams inspired a lot of responses when we published it in a recent FPM e-newsletter. Here are just a few:

I always encourage parents to have their children bring in a favorite doll or stuffed animal. After looking into the ears of the doll or stuffed animal, plus the parent's ears and mine, virtually all children, even the tiniest ones, are comfortable having their own ears examined.

I often tell young patients that there are “tiny little puppies in the right ear and little bunnies in the left ear” and I need to count them to make sure they are all there. The kids often smile when I perform the exam. If siblings are present, they often want to see the puppies.

I show children the otoscope and tell them it's a flashlight, letting them hold it and look into it. Then I tell them I'm going to look in their ear with the flashlight and ask, “Which ear do you want me to look at first?” This is great child psychology at work. Kids like to have some control. If you can get them to point to an ear, you just got permission and consent for them to hold still.

Mirror, mirror on the floor

I have a patient with peripheral neuropathy and diabetes who is unable to lift his foot to examine it every night before bedtime. He put a 12-inch mirror under his bed, which he can slide out with his foot, use to examine both feet, and slide under the bed again. This works great for people who need to look at their feet daily but don't have the mobility to lift their feet to see the soles.

Exercise isn't just for patients

Doctors regularly advise more exercise for patients whose jobs provide little moderate to vigorous physical activity. That could describe a lot of jobs in physician practices. To encourage more physical activity in your practice, structure group exercise breaks, promote using the stairs instead of the elevator, or place employee parking spaces farther away from the building. Offering 10-minute activity breaks for meetings lasting longer than an hour can also liven things up.

Source: Yancey AK, Sallis RE, Bastani R. Changing physical activity participation for the medical profession. JAMA. 2013; 309( 2): 141– 142.


Preserving patient records after shutting your doors


I am closing my practice. How long do I need to keep patients' medical records?

There is no standardized record retention schedule that all organizations and providers must follow. Laws regarding medical record retention are passed by state legislatures and should be available from your state health department or medical board. You should also be aware of certain federal record retention requirements. For example, HIPAA (the Health Insurance Portability and Accountability Act) requires Medicare fee-for-service providers to retain patient records for six years. If you are a Medicare managed care provider, the Centers for Medicare & Medicaid Services requires that you retain patient records for 10 years.


Practice Pearls presents readers' advice on practice operations and patient care, along with tips drawn from the literature. Send us your best pearl (250 words of less), and you'll earn $25 if we publish it. We also welcome questions for our Q&A section. Send pearls, questions, and comments to, or add your comments below.


Copyright © 2013 by the American Academy of Family Physicians.
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