Clinical Tips: Setting Up a New Office

Enhancing Adherence to Daily Chronic Disease Treatment

Acne vulgaris is a common condition that requires treatment multiple times daily. The potential for great results depends on the patient’s adherence to treatment. When doxycycline is used, I like to prescribe a 3-month supply of medication—90 to 180 pills in 1 or several medicine bottles. When the patient receives their medication, the volume of pills should impress upon them that I am serious about the severity of their disease, emphasize the importance of treatment every day, and encourage them to treat every day. The 3-month supply is also more convenient with fewer trips to the pharmacy, and the single copay should save money.

The 3-month supply philosophy may also be appropriate for sedating and nonsedating antihistamines treating itch and chronic urticaria, apremilast for moderate psoriasis and psoriatic arthritis, finasteride for pattern alopecia, and spironolactone for acne and alopecia in women. I am sure there are other medications that would also be appropriate for this systemic medication– dispensing philosophy.

Dr Wayne Fujita
Aiea, HI

Value Your Time

You may have a few patients, like I do, who come in consistently for a low number of Botox units. In many cases, I had hoped they would opt for fillers or other cosmetic treatments, but most continue with the small amount of Botox. Because I do all my own injections, this is a poor use of my time. As such, I have introduced a minimum $200 fee for any Botox that I do, so even 4 units would cost $200. Some of these patients may depart, and others may add more units to get their $200 worth. In either case, my time will be more fairly valued.

Dr Benjamin Barankin
Toronto, Ontario, Canada

Designing New Office Space

Cabinets that your nurses can reach but kids cannot. A drawer or cabinet with a lock on it. An examination table that goes low enough for older patients to get on, with a warranty on the mechanical part because the tables break a lot. Chairs to sit on that are washable, not plain fabric; yes, patients do urinate on the chairs. Locate the paper towel dispenser right over the sink, not to the side. Do not put the patient chair in the way of the sink to avoid having to step over your patient to wash your hands. And do not put your desk or any important things by the sink. Have the door oriented and opening in a direction so you cannot see the patient sitting naked on the table. You may want doors without knobs that you can push open with your foot. Lighting should be bright enough and not off-color. Also, the walls should be the right color to not make patients look blue, yellow, or pink. This list sounds crazy, but I deal with these issues daily. Keeping them in mind will help you avoid pitfalls as you set up a new office.

Dr Jo Herzog
Birmingham, AL