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Fam Pract Manag. 2010;17(2):48

Use a cell phone camera to document biopsy sites

When I biopsy a lesion and don't excise the residual myself (typically a central face basal cell carcinoma that requires Mohs surgery), it may be two or three weeks before the patient sees the surgeon. In that time the site may heal, making it difficult to tell where the abnormal tissue came from. To prevent this problem, I borrow the patient's cell phone camera after the biopsy and take pictures of the site (if the patient doesn't have a cell phone, an accompanying family member often does). Then, at the follow-up surgical appointment, if there's any question where the tissue came from, the patient can pull out the cell phone and show the picture.

Remind the patient not to erase the photos prematurely. Take at least two pictures with the camera: one close up and one wide view that shows facial landmarks.

Streamline your annual physical process

As a young physician, I was bored to tears by the ritual of the annual physical. History-taking was tedious and time consuming, and the yield was minimal. After a six-year flirtation with emergency medicine, I opened my own family medicine office, and I was determined to tame the tradition.

From the beginning, I assigned the history to a smart registered nurse who sorted out the problems and ordered appropriate labs in the patient's first visit (which I don't bill for). When I met the patient for a return visit, I already had the goods. We jumped right into problem solving, education, encouragement, medication adjustment and projections for further testing. The physical exam itself, as every experienced physician knows, takes only a few minutes. I ask for these “database physicals” only once every five years up to age 50, and every two years thereafter. This schedule has proven to be more than adequate to flush out preventable disease and handle problems proactively. The time involved in these exams may be a loss leader, but it is more than counterbalanced by the revenue from routine follow-up care and the professional satisfaction of providing quality care and proving that family medicine works. I always do a “postmortem” when a patient shows up at the hospital with a preventable disaster. Three times out of four the patient is someone who has ignored my repeated promptings to schedule a database physical.

Handling prescription change requests from PBMs

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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 or less), and you'll earn $50 if we publish it. Send pearls, questions, and comments to fpmedit@aafp.org, or add your comments below.

 

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