PRACTICE PEARLS

 

Fam Pract Manag. 2020 Sep-Oct;27(5):43.

PROVIDE PATIENT LETTERS DESCRIBING THE DIAGNOSIS RATHER THAN THE NEED FOR ACCOMMODATION

It's not unusual for patients to request that I write letters stating that they need things like emotional support animals, time off school, or some sort of workplace accommodation, such as an ergo-nomic chair. Some of these requests are more appropriate than others.

To avoid grappling with somewhat subjective questions (e.g., whether having a miniature horse around is truly necessary for a patient's emotional health), I have a stock reply for particularly questionable requests:

“I will write a letter addressed to you describing your medical history, and then you can provide that letter to anyone you want.”

This helps me avoid having to state that any specific accommodation is a medical necessity.

Patients are usually satisfied with this, and I feel better about attesting only to an objective fact — that the patient has a specific diagnosis.

REDUCE PAIN OF DELTOID INJECTION

Getting patients to overcome injection-related fears is one of the most common challenges of medicine. One painful experience as a child can lead to a lifetime of anxiety about trips to the doctor's office. But we've found an easy distraction technique that seems to work.

Most vaccines are administered through intramuscular injection of the deltoid muscle, usually by inserting a 1- to 1.5-inch needle at a 90-degree angle, 2.5 to 5 centimeters below the acromion process bone.

If you pinch the skin between the thumb and index finger while concurrently applying downward traction inferior to the injection site, the patient rarely feels the pain of the needle. Rather, the patient concentrates on the annoyance created by pinching the sensory division of the axillary nerve.

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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 fpmedit@aafp.org, or add your comments below.

 
 

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