Fam Pract Manag. 2006 Apr;13(4):70-73.

Know when to ask for help

If you haven’t figured out a tough case within three visits, get a consultant. Two brains are often better than one, and a timely referral will reduce your liability risk in a malpractice case.

Send reminders for needed lab work

When we review lab results for a patient with chronic illness, we write up a new lab slip that we file for three months or until the patient needs to be checked again. At the beginning of each month, our medical assistant checks the file for that month and sends the lab slip to the patient.

Encourage appropriate dress in your office

Getting staff to comply with an office dress code can be hard. If you’d like to implement a new dress code or you’d like to enforce the current one, keep the following in mind:

  • Effectively communicate to your staff the reason for the dress code. Let them know that you want your practice to convey a clean, neat and professional image.

  • Give specific guidelines for your staff to follow. If skirts need to be knee length and men must wear collared shirts, say so. Don’t just say skirts are acceptable and men should wear dress shirts, as these general guidelines can be misinterpreted.

  • Speak one-on-one with staff members who are not complying. Before speaking with each employee, consider why they may not be complying (for example, they can’t afford a new wardrobe or want to show personality) and think through how you might respond. Discussing attire can be a sensitive issue, so acknowledge that before giving guidance.

  • Be an example for your staff. The best way to let your staff know what you expect is to show them by following the dress code yourself.

Source: Employee orientation guidelines – dress program basics. Michigan Department of Civil Services.


ED work and opting out of Medicare


I plan to set up a private practice in which I’ll opt out of all insurance contracts. I want to collect my fees, give patients a receipt and let them handle their own claims. I plan to continue working part-time as an emergency department physician, where I am paid an hourly wage by the hospital. Can I opt out of Medicare, even though I take care of Medicare patients in the emergency department?


Although opting out of Medicare is usually an all-or-nothing proposition, there is an exception in the rules that would allow you to opt out and continue your emergency department work. The beneficiary must not be charged more than the Medicare limiting charge (115 percent of the Medicare allowable) for the service you provide, and a claim must be submitted to Medicare on behalf of the beneficiary. Modifier -GJ, “Opt out physician or practitioner emergency or urgent service” should be appended to the code(s) for the service(s) you provided. This indicates to the payer that the service was furnished by an opt-out physician who has not signed a private contract with a Medicare beneficiary for emergency or urgent care items. It also indicates that services furnished to, ordered for or prescribed for the beneficiary occurred on or after the date the physician or practitioner opted out. Emergency services are defined as services furnished to an individual who has an emergency medical condition as defined in 42 CFR 424.101. Urgent care services are defined in 42 CFR 405.400 as services furnished within 12 hours in order to avoid the likely onset of an emergency medical condition.

For more information, see chapter 15, section 40 of the Medicare Benefit Policy Manual online at

Source: Kent Moore, AAFP, Leawood, Kan.


Promote patient education with podcasts

For the past six months, I’ve been experimenting with a new way to offer patient education: podcasting. Podcasts are audio recordings that are available on the Web. Patients can either download my podcasts from my Web site at and listen from their computer or they can store the recording on an mp3 player and listen to it later. My podcasts, which are free for listeners, are presented in a radio talk show format with a different health focus each week. For my first podcast, I talked about healthy living, and my most recent recording concerned staying healthy while traveling. They are usually 15 to 20 minutes long. Patients are able to listen when it is convenient for them, and they only listen to what they want. The response from my patients has been positive.

My decision to begin podcasting came after a routine conversation with one of my patients revealed that he had the technical skills to create a podcast. He volunteered to help get my podcasts from the recording studio (my office) to the Web and even acts as the interviewer each time I record a new podcast.

If you’re not lucky enough to discover a podcasting expert in your patient panel, CNET provides a step-by-step guide to creating a podcast at–11293_7–6246557–1.html. Family physicians with computer skills might enjoy the challenge of putting a podcast together, and patients will certainly appreciate the convenient and educational final product.

Show your appreciation for your staff

In family medicine, a practice’s most important resource is its staff, so remember Nurses’ Day, Secretaries’ Day and special occasions in their lives. Have a small party or just bring dessert to the office. When you do the small stuff, it lets your staff know how much you appreciate them and that you consider them an integral part of making the office run smoothly and efficiently.


Practice Pearls presents the best advice on effective, efficient practice operations and patient care drawn from the medical and business literature, along with tips developed from your experience. Send us your best pearl (250 words or less), and if we publish it, you’ll earn $25. We also welcome questions for our Q&A section. Send your pearls and your questions to us at


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 $50 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 © 2006 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Sep-Oct 2021

Access the latest issue
of FPM journal

Read the Issue

FPM E-Newsletter

Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights."

Sign Up Now