tips and tricks

Practical Pointers: Discover Shortcuts Devised by Colleagues (December 2010)


Let Mom Scope Out the Throat

Young children are usually fearful of the otoscope and tongue depressor in the hands of a physician. To ease their fears, I give the otoscope to their mother and stand close behind her and examine the throat. This approach has been very successful.

— Bhagwan D. Bang, MD
    Opp, Ala


Stop the Talking and Start Listening

Often patients don’t realize that during auscultation of the heart and lungs we can’t hear them, and they continue to talk. One way to help prevent this is to listen to the lungs first instead of the heart. Ask patients to take deep breaths and they will stop talking. This strategy will allow you to conduct a thorough lung and heart examination.

Gregory S. Morales, MD
    Los Angeles

Calcium for Muscle Cramps

Consider prescribing calcium with vitamin D (600 mg/400 IU, 2 or 3 times a day) for patients who have nighttime leg cramps. This works very well and is much better tolerated and safer than quinine. Remember that calcium carbonate (unless chewed) requires an acidic environment, so patients who are taking acid reducers should use calcium citrate.

Jason Sims, DO
    Cleveland, Okla

Improve Your Rapport With Kids

If a child seems frightened or cries during the physical examination in a way that limits your ability to do a proper assessment, try this trick. Once you notice apprehension, finish a cursory exam and let the parents know you will be back later to recheck. If you are lucky, on the second visit to the bedside, the child will remember that you were not "dangerous." Often, with each subsequent visit, the child will warm up to you more and more, allowing for a more reliable examination and a better experience for all.

D. Brady Pregerson, MD
    Los Angeles

Fresh Eyes Find Time

Ask a colleague to visit your practice and point out ways to improve efficiency. Sometimes it’s hard to see a problem when you’ve been working around it for years.

Courtesy of
    Physicians Practice

Not for Women Only

Men who have undergone local procedures in the genital or anal area (eg, abscess drainage) find it difficult to get a bandage to adhere to the skin because of the pubic hair. Shaving the area increases the risk of infection and is also something many patients prefer not to have done. A women’s mini sanitary pad applied to the man’s underwear over the site of the procedure is frequently sufficient to absorb the blood or drainage. We keep a few pads in stock so that men can avoid the embarrassment involved in shopping for "feminine hygiene products."

Lawrence Adler, MD
    Beverly Hills, Calif

Bill for It All

Too many physicians forget to bill for supplies and imaging services. To double-check yourself, match invoices from your medical supply and imaging vendor to supplies and imaging services you billed for.

Courtesy of
    Physicians Practice