When Doctors Think Out Loud

September 3, 2009

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.


    Kay Martin September 3, 2009 at 6:57 am

    You are a very good doctor. I know this because you cured my kiddo, but the dry erase board idea is really creative and must highlight your ability to connect with parents and patients. Congrats – I'm glad the boards are a hit!

    Dr. Val September 3, 2009 at 7:07 am

    Great idea! Love it!

    Pam Moore September 3, 2009 at 9:34 am

    Great, simple solution, love it. But now we need a picture to see if you really do look like House.

    Daphne Swancutt September 3, 2009 at 9:44 am

    Great idea! You really must watch House…he uses the dry erase board, too ;-) (although not for his patients, since he doesn't really like them or care what they think).

    Janice McCallum September 3, 2009 at 11:20 am

    Thanks to Dr. Val & Daphne for tweeting about this. I like the idea very much. However, you might reconsider the low-odor markers. I find the smell of the standard markers so strong & offensive & I'm sure I'm not alone.

    DoctorNatasha September 3, 2009 at 5:11 pm

    My patients also love the boards. There is also dry erase "paint" that I have used over an entire wall. I have my nurse checking in my patients write, "Welcome, Joe, to your 5 year checkup". Kids love to see their name in lights. Did not think about the photo with the smart phone, though! Great!

    Julia Rhodes September 5, 2009 at 2:14 pm

    I have a great communication tool for you- a hand help dry erase paddle- and would be happy to send them to you as a donation for your office. I first invented the eraser cap for dry erase markers- then a hand held dry erase board ( like a ping pong paddle) with a marker and with eraser that is stored in the handle. The paddles clean up with just soap and water too! My sister who is a nurse says they are great in hospitals because it helps with communication. You can see them on my web site http://www.kleenslate.com
    Just drop me an e-mail at julia@kleenslate.com as to where to send them if you are interested.
    In admiration for being inventive!

    Doctor D September 7, 2009 at 8:57 am

    I had thought about this for my office once, but then had an experience from the patient side that turned me off.

    I took my dog to the vet and the vet did this with the dry-erase board. The effect was kind of a turn-off. It felt like a lecture from school. Rather than sitting down and looking us in the eye he was standing over us writing.

    Still a good idea, but would use caution not to end up coming across like our vet.

    DrV September 8, 2009 at 6:39 am

    Doctor D – Excellent point. Most of my engagement with parents involves problem solving so the medium is quite good for that. With heavy discussions I never use the board unless it can truly add to the discussion.

    Sarah aka Mainline Mom September 25, 2009 at 8:31 pm

    I will tell you that my friend Kristi, @moxiemomskaty, whose daughter is a patient of yours now, was VERY impressed with the dry erase board method. Well, at least she told me all about it when she recounted the story of her appt with you. So that is saying something.

    pediatric emr February 23, 2010 at 11:56 pm

    I've read from some articles that EMR serves as the bridge between patient and physician. Physicians show what's on the pc tablet or the monitor to the patients and let them know what doctors do.


    Medical Practice Management Software June 10, 2010 at 6:44 am

    That's amazing. I believe there are many benefits of using. The most important thing – It will improve the patient care.

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