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Fam Pract Manag. 2010;17(4):36

Invite patients to listen while you dictate the note

At the close of each appointment I invite the patient to listen as I dictate the note. I may stop along the way to ask a clarifying question, and occasionally the patient will correct a misunderstanding (e.g., “It was my left knee, not my right” or “The pain has been there for three months, not three weeks”). Usually, patients appreciate being included in this process, and it serves as a means of confirming that I've understood their story. Often patients are surprised by the amount of listening and thinking that goes into their care. Dictating with the patient is also a means of reinforcing the plan.

Although I was a little reluctant to do this at first because I felt self-conscious talking about patients in front of them, I now find this to be respectful, especially when the topics are particularly sensitive.

Dictating in the room is also an efficient part of my workflow: I record the note while it is freshest in my mind. For patients who have undressed, I pull the curtain and invite them to dress “while I talk to the computer about you, and then we'll sit together and wrap up.” The side benefit is that patients can have a moment with me at the end of the appointment when they are fully clothed. When I leave the exam room, all the work for that patient is complete, and my mind is uncluttered and free to focus on the next patient.

Help patients differentiate good and bad cholesterol

Patients often have a difficult time understanding the difference between types of cholesterol. As a medical student, I had trouble remembering it too! To explain it to patients, I tell them that LDL is the “lousy” cholesterol, so you want it to be “low,” but with HDL you are “happy” when it is “high” because it is the good cholesterol.

Revive the physician-patient relationship

A positive physician-patient relationship starts with good communication, which involves asking the right questions and really listening to your patients' responses. You can also endear yourself to your patients by paying attention to their emotional needs. Try these approaches:

  • Express concern for your patients' welfare.

  • Acknowledge their feelings.

  • Empathize with their situation.

  • Show compassion.

Create a “web dashboard”

It's easy to become overwhelmed with online information – e-mail, news feeds, social networks, blogs, etc. One way to stay on top of this information is to create a “web dashboard” (like the free service provided by NetVibes) that brings all of your online information together in one place.

For example, you could set up your web dashboard to display RSS feeds from your favorite medical journals, blogs and news sites or based on topics of interest; updates from Face-book friends or people you follow on Twitter; bookmarks to your favorite online resources; and even e-mail messages from your mail program.

I created my own dashboard, which is written in both English and Spanish.

Communicate well with patients when using an EHR

The physician-patient experience doesn't have to suffer when you use an electronic health record (EHR) in the exam room. Consider these things to do – and not to do:

  1. Do not complain about the EHR to the patient.

  2. Replace eye contact with voice contact when necessary.

  3. Let the patient know how you use the system to improve his or her care (e.g., e-prescribing or reminders of services due).

  4. Find something on your screen that the patient should look at with you (e.g., A1C results or a child's growth curve).

  5. Begin the visit with a warm greeting and end with a warm closure. Use eye contact and a handshake or other age- and gender-appropriate physical contact.


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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