Fam Pract Manag. 2020 Jan-Feb;27(1):34.


I recently worked with a 31-year-old patient who had a history of sexual trauma. She was motivated to have a pelvic exam and Pap test, but also anxious. Our first attempt was stopped because of her physical and emotional discomfort. I sent her home with a small, disposable speculum so that she could familiarize herself with the pelvic exam equipment at her own pace. On the second try, she was again unable to go through with the exam. She felt defeated and self-critical. I suggested that she bring her partner and premedicate with a low dose of lorazepam. She bravely returned to the exam room, feeling more relaxed but still anxious.

Then I decided to try a mirror. I had not used this strategy before, but it did the trick. She held the mirror in place and was able to see everything I was doing as I talked her through the process and her partner held her hand. She was very proud of herself and relieved that my nurse and I did not judge her or lose patience. There were big hugs and relief all around when her Pap test came back normal.


By asking older patients one question about subjective memory complaints, you can begin to assess their risk of dementia, according to research published in the September/October 2019 issue of the Annals of Family Medicine.

The query, “Do you feel you have more problems with memory than most?” is from the 15-item Geriatric Depression Scale. When administered at baseline and two-year intervals thereafter, this assessment of subjective memory complaints was a predictor of which community-dwelling older adults were likely to develop dementia.

Based on the results, the researchers suggest a three-step process for assessing dementia risk:

  1. Ask the subjective memory complaints question.

  2. If the patient answers “yes,” administer the Mini Mental State Examination-5 (MMSE-5).

  3. If the patient fails to remember all three MMSE-5 objects, give a Visual Association Test (VAT).

The researchers concluded that in people who answered “yes” to the subjective memory complaints question, “the strength of the association between future dementia and an imperfect MMSE-5 score depends substantially on the VAT score.” But they also found that “subjective memory complaints alone were associated with future dementia.”


van Wanrooij LL, Richard E, Jongstra S, Moll van Charante EP, van Gool WA. Associations of subjective memory complaints and simple memory task scores with future dementia in the primary care setting. Ann Fam Med. 2019;17(5):412–418.


Always running late at the office? Try starting each visit by telling your patients how much time you have scheduled for them.

Here’s how to do it: Enter the exam room, greet your patient with a smile, and say warmly, “We have 15 minutes scheduled together this morning. I’m looking forward to talking with you.”

Stating the amount of time that you will have together, with empathy, starts the clock ticking in patients’ minds and allows them to organize their concerns.

As the visit continues, don’t be afraid to update the patient on the amount of time remaining. For example, you might say, “We have about five minutes left. I want to make sure we haven’t missed anything important before we wrap up.”

Near the end, try saying, “I’d love to hear more, but unfortunately, we are out of time for today. Let’s schedule another appointment so we can keep working on your health issues.”

It may seem strange or even rude to tell a patient how much time you have. But I’ve found that most patients are grateful for it. It helps them stay focused on their most important concerns.

Doctors often want to try to do “everything” in one visit, but quality care comes from strong relationships and long-term health strategies. Stay focused and on time so patients aren’t hesitant to come back and continue the dialogue.

Editor's note: Dr. Bernard is co-author of Physician Wellness: The Rock Star Doctor’s Guide: Change Your Thinking, Improve Your Life.



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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