Fam Pract Manag. 2019 Sep-Oct;26(5):33.


If you suspect a patient has fractured a bone, here's a quick way to test your hypothesis using something you carry around all day.

The periosteum surrounding bones contains a lot of nerve fibers. When you break a bone, that layer gets disrupted. If you put a vibrating tuning fork on the suspected break, the patient will tell you it hurts a lot. You probably don't have easy access to a tuning fork, but you can use your mobile phone. Put your phone on vibrate, have someone call you (or call yourself on a separate line), and touch the corner of the phone to the bone in question. Patients may look at you funny. But I tell them that although I can't do a computed tomography scan in the office, I can do a phone scan.


Transitional care management (TCM) can help prevent your patients from falling through the cracks when moving between hospital- and home-based care. Despite many obstacles, two strategies have helped our practice improve the success of TCM:

1. Our hospitals and emergency departments notify us about patient visits or admissions only after discharge, which is not optimal. Our solution is to have a staff member each day review the list of admissions at all area hospitals to see if it includes any of our patients. The staff member will then proactively reach out to the discharge planner, the admitting physician, or both to plan TCM. We contact the patient before or on the day of discharge to schedule an appointment within 7 to 14 days, and a nurse calls the patient within 48 hours, both of which meet TCM coding rules.

2. We make a strong effort to personally perform preoperative clearance visits for all of our patients being admitted for procedures. During these visits,


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 © 2019 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

CME Quiz

FPM E-Newsletter

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

Sign Up Now