The Bottom Line Medicine Clinic.

The financial experience of an actual medical practice was used to develop a spreadsheet model of the business of medicine. The model is designed to provide reasonably accurate predictions of the financial outcome of business decisions affecting the practice. It has been used very successfully to teach practice management to senior residents in Family Practice training at the University of Minnesota. Students are placed in the role of a managing partner presented with a financially ailing practice, and asked to suggest business decisions which might salvage the situation. The model instantly and convincingly presents the impact of such decisions on the "bottom line". The entertaining and interactive format have made this one of the most popular offerings in our practice management curriculum.

A systematic primary care office-based smoking cessation program.

There is a large discrepancy between apparent potential and actual practice of smoking cessation activities by physicians. This paper describes the 2-year results of an integrated system to support such physician activities with all of their tobacco-using patients. The system consists of organized identification, progress records, brief physician messages, follow-up, and assistance; it focuses on those most interested in quitting. Introduction of the system to one clinic was associated with an initial threefold to fivefold increase in quit rates of all clinic patients using tobacco. After 2 years, the overall quit rate was approximately 20%, rising to 33% for those tobacco users with more clinic contacts or at least 1 year from the first to the latest contact. Such a program has been well accepted by patients, physicians, and office staff and seems to provide the support needed for a feasible and effective long-term smoking cessation intervention in primary care practices.

Differences and similarities between patient and physician perceptions of patient pain.

A reasonably accurate perception of pain severity by physicians can be a useful tool in effectively managing acute pain. This study measured the similarities and differences between patient and physician ratings of patient pain through the use of a linear analogue scale of pain severity. A total of 401 patients presenting with acute pain of up to seven days' duration were studied. Data were gathered from patients presenting to the seven family practice clinics associated with the Department of Family Practice and Community Health at the University of Minnesota. Whereas the physician mean rating of patient pain was found to be significantly lower than the patient mean rating (3.52 vs. 4.37, P = 0.001), raw ratings by physicians and patients were found to have a relatively strong and significant correlation (R = 0.66, P = 0.001). The difference in mean ratings between patients and physicians remained the same regardless of physician or patient gender, patient age, whether or not a diagnosis was made, organ system category in which the pain was located, or training level of physician. The physician mean ratings were always significantly lower than the patient mean ratings, and there was no significant difference in the mean differences in ratings among the subgroups compared.