When Doctors Think Out Loud


I recently had dry erase boards installed in my office exam rooms. I didn’t give it much thought but felt on a whim that it might help with diagrams and things. As it turns out, the result has been dramatic. Parents are crazy about them.

Here’s how I use them:  After my history and physical I summarize the 4-5 key points of a child’s story in the upper right part of the board. I then generate a small differential diagnosis in the lower right side. In the left upper side I list off what I think we should do. I also use self-scribbled schematics of the upper intestinal tract and colon to illustrate key ideas.

I used to stare patients, talk and use my index finger for ‘air diagrams’. Now I scribble in a way that parents can see. I can see parents thinking as they look, ask questions and process information. While I have no data to support it, I would be very surprised if retention were not improved. White boarding also helps me organize my own head when discussing care with a parent. At the end of the visit I transcribe my brainstorming into my EMR. Here’s my favorite part: I encourage families to photograph the board with their smartphone. They love it.

Perhaps it’s the visual thinking that appeals to patients. Perhaps it’s the perception that I’m spending more time with them.  Everybody tells me I look like House M.D. I’ve never seen House.

Carlos Rizo at Innovation Cell has written about how small changes in healthcare can have a big impact. I think he’s right. Here’s an example that was discovered purely by accident (call me the accidental disruptor).

    If you’re thinking of doing this in your clinic, spend money on quality boards.  My 4×3 Quartet boards are big enough to hold my ideas.  And stick with the the traditional ink Expo markers.  I find the low odor markers to be a bit dry.