Improve your practice: Patient visits

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

A bit of magic

If you are not rushed, patients appreciate some quality time with their pediatrician. You can tell jokes, play with puppets, engage in a game of tic-tac-toe, or show them a magic trick. I find my teenaged patients almost always have headsets attached to their smartphones that they listen to while texting. It just takes a moment to ask about their music preference and perhaps have a listen to gain their confidence before asking them medicine-related questions.

Immunizations and pain reduction

As you know, many patients are needle phobic. Some parents are needle phobic as well, so it is not a bad idea to have nurses given simultaneous injections to young infants if you have the staff to accomplish this. For the older child, consider using the Buzzy system or DistrACTION Cards for shots from buzzyhelps.com or the Bionix ShotBlocker (bionix.com), or hand them a Fidget Cube (fidgetcubeshop.co) to play with during injections.

Some patients insist on the application of EMLA cream (lidocaine/prilocaine) at home so their immunizations are pain free. Until needle-free injection systems are in widespread use, do whatever is necessary to reduce your patient’s discomfort. Children also quickly forget their injections if you cover the evidence with a colorful adhesive bandage. As these are very inexpensive, send 1 or 2 home for the child to use when the ones you apply fall off.

The best part

When patients are checking out, you have your last opportunity to keep your patients happy, or if they are tearful, to brighten their day. Traditionally, pediatric practices give parting tokens of appreciation to the child (their parent gets the bill, of course). Some older pediatricians, myself included, use to hand out lollypops but no longer do so because these are not “politically correct” and conflict with today’s messages about making good food choices. The most popular and cost-effective handouts are stickers that you can display on the checkout window and allow children to choose their favorite. Virtually every pediatrician is familiar with smilemakers.com and medibadge.com where you can get stickers galore. medibadge.com also has cool sticker-based games.

Next: Use medical websites to improve your practice

I have also given out toothbrushes (politically correct), or even plastic toys that do not have small plastic parts and are of sufficient size that they can’t be swallowed or placed in body orifices (very embarrassing). My patients’ favorite items in the past have been small containers of bubbles with wands (popular among girls) and plastic cars (top boys’ item). Older kids often choose pencils topped with colorful erasers. All these latter items can be had from orientaltrading.com.

Parting thoughts

The reason most of us became pediatricians is that we get to care for a very special kind of patient. We help parents raise their offspring in health and in illness and play an invaluable role in their upbringing. Although pediatrics is not the most lucrative of medical specialties, it has its own unique rewards. By making every effort to provide quality care, and being kind and considerate to parents and children, we can end every day assured that we did a great job!

Dr Schuman, section editor for Peds v2.0, is clinical assistant professor of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, and editorial advisory board member of Contemporary Pediatrics. He is CEO of Medgizmos.com, a medical technology review site for primary care physicians.