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Fam Pract Manag. 2011;18(3):39

Provide patients with a clear timeline regarding lab results

When I order screening labs on patients, such as a cholesterol screening, A1C test or Pap smear, I make it a habit to tell them that it can take up to two weeks to get the results and that they will be contacted by phone or letter when the results arrive. These labs usually return within seven days, but it's not always possible to assess the information and relay it to the patient right away.

Providing patients with clearcut expectations that also give me “wiggle room” helps prevent the inevitable message from my nurse: “Patient X called; she wants to know her lab results.” This saves time for my staff and me and prevents unnecessary worry in my patients.

Whistle to calm children during ear exams

I whistle while examining the ears of children. This causes newborns and infants to stop wiggling just long enough for me to see the tympanic membrane. With toddlers, I prep them by saying that there is a bird in their ear that will sing when I shine a light on it. Then I have their parents hold them in a hug, and I don't whistle until I see the tympanic membrane. For children I have cared for since birth who have never had a traumatic ear exam experience, there is no struggle to look in their ears.

The only time this backfires is when I whistle while examining the ears of adults, which I have done automatically several times. It really damages their impression of my sanity!

Keep legible notes to defend against malpractice

Some physicians actually believe that illegible notes are a good way to prevent lawsuits because they hide any evidence of wrongdoing. In reality, illegible notes provide no protection and are viewed by juries as reflecting sloppy writing and, perhaps, sloppy care. Years later, when the case finally gets to the jury, the medical record can be the doctor's best, and often only, friend as memories fade over time. Legible and logical notes detailing thoughtful care provide the best malpractice defense. The best strategy is to use an electronic health record system (it brings a wealth of information to the point of care); next best is to have notes dictated and transcribed. If notes must be handwritten, make certain they are legible.

Ask new patients how they heard about your practice

When I see patients for the first time, I always ask how they heard about our practice. Often they will say that a friend or family member recommended us because they were so pleased with the care they received.

This compliment encourages me, and it increases my desire to give the new patient the same excellent care – even if it is at the end of a long day.

Request payment at check-in

Creating a simple, standardized process for front-desk staff can greatly improve your practice's finances. Before a patient arrives for his or her appointment, a staff member should determine the patient's account balance, co-payment and deductible. Then, when the patient checks in, the staff member should ask, “How would you like to pay your balance today? We accept cash, check and all major credit cards.” Asking this question conveys the expectation that payment is due at the time of service.

Likewise, when staff members make appointment-reminder calls to new patients, they should quickly review this payment policy.


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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