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Fam Pract Manag. 2013;20(2):33

Making kids' ear exams less stressful

Editor's note: A Practice Pearl from 2011 on whistling to distract children during ear exams inspired a lot of responses when we published it in a recent FPM e-newsletter. Here are just a few:

I always encourage parents to have their children bring in a favorite doll or stuffed animal. After looking into the ears of the doll or stuffed animal, plus the parent's ears and mine, virtually all children, even the tiniest ones, are comfortable having their own ears examined.

I often tell young patients that there are “tiny little puppies in the right ear and little bunnies in the left ear” and I need to count them to make sure they are all there. The kids often smile when I perform the exam. If siblings are present, they often want to see the puppies.

I show children the otoscope and tell them it's a flashlight, letting them hold it and look into it. Then I tell them I'm going to look in their ear with the flashlight and ask, “Which ear do you want me to look at first?” This is great child psychology at work. Kids like to have some control. If you can get them to point to an ear, you just got permission and consent for them to hold still.

Mirror, mirror on the floor

I have a patient with peripheral neuropathy and diabetes who is unable to lift his foot to examine it every night before bedtime. He put a 12-inch mirror under his bed, which he can slide out with his foot, use to examine both feet, and slide under the bed again. This works great for people who need to look at their feet daily but don't have the mobility to lift their feet to see the soles.

Exercise isn't just for patients

Doctors regularly advise more exercise for patients whose jobs provide little moderate to vigorous physical activity. That could describe a lot of jobs in physician practices. To encourage more physical activity in your practice, structure group exercise breaks, promote using the stairs instead of the elevator, or place employee parking spaces farther away from the building. Offering 10-minute activity breaks for meetings lasting longer than an hour can also liven things up.

Preserving patient records after shutting your doors


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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