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Fam Pract Manag. 2008;15(9):42

"Puzzle" your patients while they wait

Even though we have a television, fish tank and play area in patients still sit and stare at the receptionist while waiting to be called back to the exam room. To fix this, we added another form of entertainment to our waiting room: a jigsaw puzzle. Sometimes as many as four or five patients work on the puzzle at one time. It makes their wait time pass quickly and makes their “together” time more enjoyable. You know what they say: “Time flies when you're having fun.”

Find ICD-9 codes in a snap

A bout five times a day, I need an ICD-9 code that I don't have handy. FPM publishes a great list annually (which you can download at but using a spreadsheet or printed copy to find a code can be cumbersome. To aid my search, I created a simple Web page that features ICD-9 code autocompletion. It allows the user to type a few characters of the diagnosis and be presented with the complete code. For example, typing “eus” produces “381.81 Eustachian tube dysfunction.” This tool, which we've incorporated into our practice Web site, allows me to quickly find the code I need in less time than it would take me to flip through a coding book, and usually with better results. My fellow practice members use it multiple times daily as well.

Editor's note: Visit FPM's ICD-9 coding page ( to try out Dr. Ploudre's ICD-9 tool or to download the file and make it part of your own Web site. It has been updated with the current ICD-9 codes.

Start later, end later

We have changed our standard office hours to begin in the mid-morning and end in the mid-evening. This allows full-time, 8 a.m. to 5 p.m. workers to see a family doctor without having to rearrange their work schedules or take time off.

Dictate chart notes with the patient present

I've found that my process of dictating chart notes in front of my patients has a number of advantages:

  • Patients can interrupt me if I dictate anything incorrectly, and I encourage them to do so.

  • If I can't remember something, I can stop and ask about it.

  • I have another chance to answer any questions patients might have. At the conclusion of the dictation, I simply ask, “Do you have any questions?” Once I've answered those questions, or if they don't have any, I end the dictation with, “All patient questions answered. Dictated in the presence of the patient to ensure accuracy.”

Another advantage of this system is that because patients experience the dictation process, they give me “credit” for the time I spend on it.

Display art from students

I asked the art teacher at our local elementary school to have the kindergarten and first-grade students create artwork for my office waiting area. I purchased simple frames that they use to display their work. We feature new art every six months, or as often as the art teacher wants. The artists and their parents love to come into the office to see their work displayed, and my patients love it too. This idea has provided fun, lively decor at an affordable price.

Create a protocol for drug substitutions

Our front office was receiving lots of calls from area pharmacies asking for authorization to substitute an alternate gastrointestinal drug when the one prescribed wasn't on the formulary of the patient's insurance plan. To save clinical staff the time it would take to process these requests and to help avoid delays patients might experience with getting their prescriptions filled, we developed a protocol that allows front office staff to authorize these substitutions. The protocol simply lists the prescribed drug with the approved substitute drug.


Practice Pearls presents readers' advice on practice operations and patient care, along with tips drawn from the literature. Submit a pearl (250 words or less) to FPM at

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