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Fam Pract Manag. 2009;16(3):29

Ask patients to rate their wellness

At the end of my subjective data gathering during an office visit, I ask the patient to rate his or her sense of overall wellness or well-being on a scale from one to 10, defining "wellness" or "well-being" in any way he or she wishes.

I then ask the patient to tell me what would make this number greater by one or two. It is important to give the patient time to answer this question without giving examples or leading the patient to an answer. I note the rating and comments in the chart and use this exercise at subsequent visits to see whether the patient has made progress.

I have been doing this exercise for several years, and I have found that it is a great way to pinpoint stress and problems in patients' lives and to help them think about possible solutions.

Use screen savers to encourage health screenings

If you have computers in your exam rooms, use the screen saver function on those computers to customize reminders to your patients for routine and preventive checkups and other services specific to your practice.

Ease the challenge of warfarin dosing

I use a dosing protocol for warfarin that is adjusted based on a weekly dose, not a daily dose.

To increase or decrease a patient's dose by 5 percent to 10 percent, adjust the weekly total dose and then divide by seven, rounding to the nearest 1/2 mg to come to the daily dose. This is much more accurate than adjusting by the daily dose, and it reaches a therapeutic level sooner.

For a patient who is already taking warfarin and only needs a slight dose change, our medical assistant usually makes the adjustment. She almost always uses a 10 percent adjustment, but the 5 percent to 10 percent range allows her the flexibility to get to the 1/2 mg dose change. The medical assistant contacts the doctor if clarification is needed or if the dosage falls outside of the norm.

We've also eliminated all odd-day dosing, which was common when warfarin was only available in 5 mg tabs. Patients are more likely to take their medication correctly if the dose is the same every day.

I have used this system for warfarin dosing for nearly 10 years with positive results.

Editor's note: Download an evidence-based anticoagulation flowsheet for outpatient warfarin management from the FPM Toolbox at

Find the right job

In the current economic climate, good jobs can be hard to find. If you're looking for a permanent or locum tenens position, a few simple reminders may aid your search:

  • Be open-minded and fl exible. Consider positions you haven't in the past.

  • Register with job placement agencies to broaden your possibilities.

  • Update, revise and store all job application documents electronically. Creating PDFs of these files can also make electronic distribution easier.

  • Create a credentialing package that includes letters of reference from the locations you have practiced.

  • Review contracts carefully, and remember that the best position for you may not be about the compensation.

Promote preventive services over the phone

When patients call the office with specific requests for things like medication refills, my staff has been instructed to take an extra minute to ask if they are up-to-date on preventive health services such as mammograms, vaccinations and Pap smears.

We've found this to be a valuable opportunity to promote prevention to the many patients who visit the doctor infrequently.


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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Copyright © 2009 by the American Academy of Family Physicians.

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