Fam Pract Manag. 2018 Mar-Apr;25(2):42.


To avoid burnout as a busy family physician, it is important to remind yourself each day of your mission and what brings you joy. Developing strong relationships with the right team of physicians and staff can also make your day so much better.

My team holds a huddle at the end of each day where we ask, “What joyful thing happened to you today?” or “What joy did you find in family medicine today?” The discussion that follows helps us remember why we are here.


Heart murmurs are a common clinical finding in children and one of the most common reasons for referring pediatric patients to cardiologists. However, most of these murmurs turn out to be the result of normal blood flow, not symptoms of underlying heart disease — a fact that does little to reduce parental anxiety or expensive evaluations.

A recent study suggests that how you listen for a murmur may make all the difference. Researchers considered 194 pediatric patients who had been referred to pediatric cardiologists for evaluation of a heart murmur. The cardiologists listened for a murmur first while the patients were lying down and again once the patients stood up. For 100 of the patients, the murmur disappeared completely upon standing. To be sure, the patients were then given an echocardiogram. Only two of the 100 registered an abnormality, and only one of those actually required intervention. Overall, 30 of the 194 participants had abnormal findings on echocardiogram that explained the murmur.

Although the study is limited, it does point to a possible way of reducing the number of false alarms among pediatric patients.


Lefort B, Cheyssac E, Soulé N, et al. Auscultation while standing: a basic and reliable method to rule out a pathologic heart murmur in children. Ann Fam Med. 2017;15(6):523–528.


Medical practices and hotels may not have a lot in common, but both are in the business of meeting customers' needs. As such, several principles that have helped the hospitality industry improve customer service may work well for your practice too.

  • Encourage employees to use their creativity and agency to serve patients better. For instance, ask staff to look for ways to improve customer service and implement the best ideas. Even staff who rarely interact with patients directly can offer helpful perspectives. Also, cultivate a service mentality by screening prospective hires for it. Ask for examples of when they've taken care of people's needs.

  • Identify a single overarching goal related to patient service. You can then break that goal down into smaller subgoals as needed. Your goals should all be tied to a clearly measurable result (e.g., patient satisfaction scores) and have an end date so you can track progress.

  • Know what to do if a patient is unhappy. The hotel chain Marriott uses the “LEARN” approach — listen to the customer's description of the problem, empathize with the person, apologize, react by offering a solution, and notify the rest of the team so they can make sure the customer's problem has been solved or offer additional solutions. For this to work, employees must be given the authority to do what is necessary to solve the problem, as long as it doesn't damage the practice or violate ethics. This gives patients a better experience and gives employees more ownership in their work.


Squires G. Three lessons health care can learn from the world's largest Marriott. Institute for Healthcare Improvement website. Published Nov. 29, 2017. Accessed Jan. 26, 2018.


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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