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    Improve your practice: Patient visits

    In this consumer-driven age, pediatricians must provide good medical care during office visits while creating a pleasant experience for children and parents.

    Previous Peds v2.0 articles have discussed how to improve the parent visit experience by improving workflow, reducing paperwork, and providing diagnostic and treatment options and education. In this month’s article, I’d like to focus on improving the experience for your young patients. Children are sometimes fragile, often fearful, and frequently needle phobic, so you should make every effort to gain their trust and confidence. If you provide a good visit experience for children, you will be rewarded with parental loyalty, a busy, prosperous practice, and patients who look forward to their office visits.

    Arrival

    Children have every reason to be apprehensive when they arrive in the office. After all, you administer immunizations, prick fingers, and squeeze their arms with blood pressure cuffs. Also, some physicians continue to wear intimidating white coats. You need to make every effort to offset the negative experience with as many positive memories as possible. This can be achieved by being calm and patient, wearing colorful ties or bandanas, reducing discomfort during immunizations, remembering to smile, and “entertaining” your patients whenever possible.

    When patients enter the practice, the waiting room is your first opportunity to impress. This means a pediatric practice should have a variety of entertaining and interesting items that attract attention, such as a fish tank, a play cube, a play wall, or a series of tablets preloaded with games and puzzles for children. It is fun to shop for these items on the Internet. Check out Playscapes.com, Kindermark.com, the-toy-palace.com, and skyfactory.com for examples of items that will make your waiting area awesome.

    No matter what you choose, be sure that all items are easy to maintain and sanitize. There are services that will maintain your fish tank. Parents may be hesitant to take their children to a pediatrician who has dead fish in the fish tank, so choose some hardy varieties or invest in a “digital aquarium” from skyfactory.com. Make sure your cleaning service cleans the play cube surfaces thoroughly every evening.

    You can avoid the need for a “sick child” waiting area by triaging entering patients and rooming those with potential contagion immediately. Lastly, all practices should have guest wireless access because so many children and parents bring their own mobile devices and entertainment with them. Make sure your Wi-Fi is secure and easy to log onto.

    In the exam room

    Please, please, please hide or keep the exam gloves out of reach. For some reason, young children consider their pediatrician’s exam room as an opportunity to deplete whatever is left open on your desks—tissues, gloves, tongue blades—because these items always invite inspection. Gloves make excellent “chicken balloons,” and although some pediatricians encourage this behavior, balloons can be dangerous as they pose an aspiration risk. Instead, consider having a drawer with crayons and coloring pages (not coloring books) available to keep kids occupied while they wait for your arrival. Coloring pages can be obtained at medibadge.com. Label the drawer inviting kids and parents to look within, and duplicate the contents and position of the drawer in each of your exam rooms for consistency.

    Consider buying table paper that can be colored (quickmedical.com) or that has preprinted entertainment (coloring pages, word search puzzles, or tic-tac-toe games [SquirrelyScrolls.com]). If you are worried, crayon can be easily removed from walls that are painted with the correct paint—so avoid wallpaper. Older children can be provided with an Etch A Sketch, a wooden puzzle with just a few pieces, or play tablets. The idea is to keep children occupied with items that are safe, inexpensive, and easily cleaned.

    Recommended: Improve your practice by facilitating patient access

    If you screen patients for hearing and vision, do so with devices that are kid friendly. For example, the Madsen Alpha OAE (otoacoustic emissions) screener from Otometrics (Schaumburg, Illinois), discussed in last year’s best tech article), has a cartoon mode that makes it especially easy to use with young patients. The company’s Sentiero Desktop advanced model includes OAE testing, tympanometry, and pure tone audiometry, plus a cartoon option for young children. It also has a special mode that facilitates simultaneous testing of both ears.

    Dressed or undressed?

    Some pediatricians insist that all patients undress down to their underwear and don a paper gown prior to the exam. I am among those who feel that this makes many young children uneasy, and so I leave them dressed and work around the clothes to perform my exam. This not only saves an office expense, but keeps patients warm as well. It also provides the opportunity to educate some forgetful children about the advantages of wearing underwear.

    Breezing through the exam

    If you are an experienced pediatrician, you know how to talk to young children. It takes 2 seconds to demonstrate your exam on a teddy bear kept in each exam room, so the child is less fearful when he or she is examined. You can also show the child how pain free the otoscopic exam is by placing the otoscope in your ear and asking the child to look through the window.

    It is often difficult to get a child to open his or her mouth to say “ahh.” I find using flavored tongue blades (superduperinc.com) or flavored/colored tongue blades (alimed.com) makes this a bit easier. Pediapals.com distributes animal covers for your stethoscope, reflex hammers shaped as either a giraffe or dinosaur, and animal-shaped otoscope speculums that can be used to engage your patients. All these items are well worth the small investment of time and money to make your exam a pleasant experience for fearful patients.

    NEXT: Easing needle phobia

    Andrew J Schuman, MD, FAAP
    Dr Schuman, section editor for Peds v2.0, is clinical assistant professor of Pediatrics, Geisel School of Medicine at Dartmouth, ...

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    • jjfraser@------.edu
      How do you deal with parents who threaten the misbehaving patient with a shot by the doctor, while in your presence???

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