Fam Pract Manag. 2008 Apr;15(4):44.

Monitor records transfers

I've found that monitoring requests from patients to transfer their medical records can be an important tool for gauging patient satisfaction. Periodically my staff sends me a list of all the transfer requests. If I see a trend of patients moving to another physician in our area, I call and ask these patients about their reasons for changing practices. This has helped me to identify some issues with our clinic that we have been able to fix. It has also given me the opportunity to personally apologize to patients, as needed. We have been able to retain some patients in the practice as a result of my calls.

Use analogies to increase patient compliance

Patients often tell me they aren't taking calcium or vitamin D supplements, despite my recommendations, because they are taking prescription medications that treat their osteoporosis. When this happens, I respond with an analogy about building a “house of bricks.” The prescribed medications will strengthen the bricks, but taking the prescription alone is like stacking brick upon brick without the mortar that holds it all together. After hearing this analogy, the majority of my patients report at their next visit that they are taking the supplement as well.

Have a garage sale

My multispecialty practice sponsors a quarterly “garage sale.” Employees donate books, cassette tapes, CDs and DVDs to sell to patients or other staff members. The money the sale generates is used to help fund holiday parties and other office functions as well as prizes for employees of the month. This activity brings together staff from different departments and helps them find new homes for items they no longer use.

Focus on special needs

Our residency practice has made multiple changes to provide better care for our patients with disabilities:

  • We display posters in our waiting area and exam rooms to show our patients that we believe in the “person first” philosophy, not only in our language and etiquette but also in our medical treatment.

  • We have enlisted two patients with disabilities to advise us on how to better meet the needs of this group. The advisers are paid a small amount to participate in monthly hour-long meetings by teleconference or in person. Their suggestions have been invaluable.

  • We flag the records of our patients with special needs so that we can anticipate their visits.

  • We have invited community advocacy organizations (e.g., the Center for Independent Living) to help us improve.

  • By taking these steps, we are providing better care and are working toward becoming our patients' medical home.

Tracking follow-up care


Do we have a legal obligation to ensure that our patients receive necessary follow-up care? We usually give patients written instructions at the end of their visits that address issues such as when to schedule their next appointments.


If you tell patients when to return and document your instruction, you have fulfilled your legal obligation. However, payers and others who measure your practice's performance may see your patients' noncompliance as an indication of diminished quality of care, particularly where chronic illness care is concerned. I would suggest having patients with chronic illnesses sign a document when you begin treatment stating that they understand the need for regular office visits and the importance of following your recommendations. Abnormal test results do require timely follow-up, of course.


Practice Pearls presents the best advice on effective, efficient practice operations and patient care. 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.


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