November 2004

Contributed by readers • Edited by Donald B. Middleton, MD
 

GET THE PICTURE

These days most subspecialists document their findings with pictures, yet cameras remain foreign to the office or emergency department. Dr. John Wipfler in Peoria, Illinois, advises that a camera can be most useful to document injuries, rashes, and unusual medical cases. In cases of suspected child abuse, it is essential. I think that many find a camera difficult to use to reflect the true nature of a problem. When you do, be sure to get appropriate permission according to your institution's policy.
 

CUE CARD

Patients who have sustained a concussion are often confused and lack short-term memory. They may ask the same questions over and over: "Where am I? What happened to me?" In severe cases, Dr. Stephen Acosta in Portland, Oregon, writes the answers to these questions on a card and hands it to the patient. Rather than continuing to repeat information, he gently reminds his patient to review the card as questions arise, as often as necessary.
 

REWRITING THE SCRIPT

Dr. Bernard Bronczyk in Columbus, Ohio, likes to carry small file folder labels in his shirt pocket or doctor bag to facilitate the process of changing a direction on a medicine bottle. He writes the new direction on the self-adhesive label, then tapes it onto the bottle so nothing can be misunderstood. The process sounds a lot easier then trying to write on the old label, which is all too often covered with clean tape that repels ink.
 

TEA FOR TOOTH

For a bleeding socket after tooth loss or extraction or even a simple lip or gum laceration, Dr. Michael Jaeger in Tivoli, New York, suggests a teabag moistened with cold water as an astringent compress to quickly stop the bleeding.
 

SCOPE SECURITY

In the September 2003 "Tricks of the Trade," Dr. Chris Dutra suggested wrapping tape around the metal tip of a stethoscope with a missing earpiece. In Far Rockaway, New York, Malka Messner, RPA-C, prefers a preventive approach: When she gets a new stethoscope, she superglues the earpieces onto the screw threads of the metal. The tendency of the entire instrument to disappear is a problem that remains unsolved.
 

TAKE A SEAT

Patients appreciate time with physicians when they do not feel well. From Los Altos, California, Dr. Gus Garmel reports that he always tries to sit down with patients during his interview. Not only does this save wear and tear on his body, but, more importantly, patients interpret this act as if he were spending more time with them, paying closer attention to their concerns, and taking these concerns seriously. In fact, if no chair is available in the room, he respectfully excuses himself to go and fetch one, medical circumstances permitting.
 

THE DREADED ZIPPER

When confronted with a penis caught in a zipper, Dr. Ariel Marks in San Carlos, California, puts viscous lidocaine around the caught skin, waits a few minutes, and then drips mineral oil on the zipper, allowing the skin to be more easily manipulated out of the zipper. Dr. Marks finds this method to be superior to injection anesthesia, either local or regional. Clearly lubrication is critical, but almost any attempt at anesthesia for these cases leaves something to be desired. Sometimes just sacrificing the zipper by pulling the teeth apart below the caught skin and working up is the best solution.