Critical Practice Foundations

Critical Practice Foundations

The Basics

Most doctors, when starting their practices, miss some of the basic actions that should be established prior to opening.

An owner of a healthcare practice should always, as a first step, work out the following basics: their purpose as a practice owner, the actual product of the practice, and the statistics that will measure the success of the practice.

Below are examples that you can modify and use for your own practice.

Purpose of the Practice Owner

The owner’s purpose is to establish an efficient health care practice that delivers quality service to its patients and/or clients and to have a very solvent and viable practice that provides an enjoyable place for the staff to work and a high quality-of-life for the doctor/owner.

Once the purpose has been established, it is the owner’s responsibility to set the direction and the pace for the business and to demand that the valuable final products of the organization be achieved. To do that, she/he must work out what the product of the practices are. Here are some examples of products:

  • A solvent, viable, expanding practice that delivers high quality care and service
  • Satisfied patients and clients who have received high quality care and service
  • Statistics
  • Number of active patients/clients
  • Production
  • Collections
  • Net Income
  • Solvency (the amount of cash versus the amount of bills owed)

Putting the purpose, product and statistics in place will help create a strong foundation for the expansion of your practice.

Getting your staff on board with you is another part of this process.

Instantly receive the second part of this article, Getting Your Staff on the Same Page. Simply fill out the form to the right. Go to the form. Scroll to top


Request Part II: Getting Your Staff on the Same Page (highly recommended).

I am interested in this topic. I would like to receive no-cost, no-obligation personalized guidance on how I can properly apply these fundamentals to my practice (highly recommended).

Guidelines Change for Preventive Antibiotics

Guidelines Change for Preventive Antibiotics Before Dental Work

According to new guidelines, far fewer people need preventive antibiotics before dental procedures than previously recommended, according to a recent issue of Mayo Clinic Women’s HealthSource.

The use of preventive antibiotics for people with certain heart conditions stemmed from worries about endocarditis. That condition is an infection of the thin membrane that lines the chambers and valves inside the heart, called the endocardium. Endocarditis occurs when bacteria or germs from another part of the body, such as the mouth, enter the bloodstream and travel to the heart and attach to abnormal heart valves or damaged heart tissue.

An American Heart Association (AHA) committee found that for most people, the risk of endocarditis from dental procedures was low. Daily activities, such as brushing, flossing or chewing, are much more likely to cause endocarditis than are bacteria that enter the bloodstream from a single dental procedure.

“Preventive antibiotics before dental work are now recommended only for people who, if they develop endocarditis, are more likely to die or have serious complications,” says Walter Wilson, M.D., an infectious diseases specialist at Mayo Clinic. Dr. Wilson headed the AHA committee that recently revised the guidelines.

The new recommendations suggest preventive antibiotics before dental work only for those people with artificial heart valves, a history of infective endocarditis, certain forms of congenital heart disease and cardiac valve abnormalities following a heart transplant.

Preventive antibiotics are no longer recommended for many people who have common heart conditions such as mitral valve prolapse or rheumatic heart disease. Before their next dental visit, patients who have taken preventive antibiotics should check with a doctor or dentist to discuss the guideline changes and determine if the medication is necessary.

Source: Newswise

An Eye Disease or Systemic Disorder?

Hearing Loss Study Adds to the Evidence

Shahin Yazdani, MD, and his research team evaluated whether patients with ocular pseudoexfoliation syndrome—the most common cause worldwide of the form of glaucoma known as “secondary open angle”—had a higher incidence of hearing loss. In ocular pseudoexfoliation (also called “exfoliation”) syndrome, fibrous white deposits aggregate on the iris, lens and other parts of the eye and can block fluid drainage; this blockage increases intraocular pressure, which can damage the optic nerve. Similar fibrillar deposits have been found in the heart, blood vessels, lung, liver, kidneys and skin of patients with ocular pseudoexfoliation. In addition, pseudoexfoliation has been associated with ischemic heart disease. systemic hypertension, aneurysms, Alzheimer’s disease, and age-related macular degeneration (AMD). The researchers hypothesized that the hearing organs might also be affected after noticing hearing disability in many pseudoexfoliation patients.

The case-control study enrolled 83 patients with ocular pseudoexfoliation and 83 controls matched for age and gender. Hearing loss was significantly more prevalent in patients with pseudoexfoliation than controls —-94 percent versus 69.9 percent. Below-average hearing thresholds were also significantly more common in ears of cases versus controls, 88.4 percent and 53.6 percent respectively. As in past studies, no definitive correlation was found between glaucoma and hearing loss. The authors conclude: “The findings of the present study imply that this apparently ocular disorder may truly be a manifestation of a systemic condition that affects multiple organs throughout the body.”

Ophthalmologists are urged to consider the possibility of hearing loss in patients with ocular pseudoexfoliation syndrome and guide them to additional medical care as needed.

Source: Newswise

Search Engine Marketing for Practices

(Article 2 of 4 Part Series)

By Lisa Thayer,

“Spiders and crawlers and bots…oh my!” – Two views of the same website

One of the most challenging aspects of optimizing a website is that there are two audiences to appeal to: 1) standard website users (like you and me) and 2) search engines. There are many similarities in attraction but also some very important differences.

First, let’s take a look at the top four usability issues from a human/standard user’s viewpoint:

* Ease of navigation – This is no time to be overly “creative” and make visitors guess where to find pertinent information. Sounds like a deceptively simple piece of advice but you only have an average of 8 seconds to capture your audience’s attention. After you have spent time and effort driving traffic to your website, don’t lose them by frustrating them! One navigational tool users appreciate is the addition of a “site map” or hierarchal list of the pages of your website.

* Visually attractive – If it looks like a high school student created your website, it will adversely affect your business’ public profile. If you don’t care about your professional image, the customer might also think you don’t care about the quality of your work. Keep in mind that the internet allows individuals the chance to anonymously pre-screen your business. You may truly have a solid, reputable business but if your website doesn’t have a good design with the proper aesthetics and technical capabilities, you’ll present a poor image of yourself. Unless you know how to design a website with these attributes, you should retain the services of a web designer and developer.

* Content-rich – Studies show that website visitors read websites like billboards not novels. Make sure that whoever writes the copy for your website is familiar with this very important difference in writing for the web. Place your most important content “above the fold” so that the user doesn’t have to scroll down unless they need more details. Make your website more relevant to the user by providing a set of Frequently Asked Questions (FAQ). Don’t be afraid of having a page of categorized links to other website resources but, of course, ask that they in turn link back to your website. Also, be sure to update your content as information in your industry changes as this will garner more frequent, repeat traffic.

Speed – In our increasingly fast paced society we have little tolerance for time wasters such as watching someone’s fancy animated intro or waiting for a picture to download. Use animation sparingly for maximum impact and to respect visitor’s time.

Not every website on the Internet gets the majority of its traffic from the major search engines, but you can’t afford to ignore them. Search engines processes and methodologies are quite complex and are updated all the time. The simple explanation of how search engines work is: the user types a query into a search engine which quickly sorts through literally millions (sometimes billions) of pages in its database and produces matches /results ranked in order of relevancy.

A search engine’s database is culled from a variety of sources.* Many of the larger search engines use things called web “spiders”,” crawlers” or “bot” programs that search the Internet in a methodical way to index and find new or updated data.

The most important thing for a website owner to know is that due to the use of these automated spiders some content and links displayed on a web page may not actually be visible to the search engines.

Now, let’s take another look at the top four usability issues – this time from a spider’s viewpoint:

* Ease of navigation – A spider isn’t concerned about getting lost – either you provide an easy roadmap to and through your website or it simply doesn’t exist in the spider’s mind; metaphorically speaking of course. The best way to do this is by adding a site map.

* Visually attractive – Web spiders don’t have eyes therefore even an actual picture of Bigfoot would have no effect on relevance. Search engines don’t index images; they won’t index any text your web site presents in image format. To fix this problem, you can use what are called “ALT tags” or image descriptions in your website coding.

* Content-rich – Content is also king when it comes to web spiders but beware… search engine methodologies have evolved to identify redundant text and the overuse of keywords. This means some of the tactics ethically challenged web designers used a few years back no longer fool the search engines and can actually harm your standings if overused. Search engine methodologies these days even go so far as to calculate the ratio of actual text (content) to the amount of coding. Web spiders also consider the information within three clicks of the home page to be most relevant to a search. Spiders, as well as human users, appreciate fresh content. (I will address the important issue of updating content in the next article.)

* Speed – Although search engines generally won’t penalize for the use of frames, dynamic content and multimedia files, they will have difficulty indexing them. They also don’t index pages that require registration, “cookies” or passwords.

I have seen many business owners make the mistake of designing an elaborate website and then seek out a professional SEO (Search Engine Optimization) expert. This can lead to disastrous results such as poor performance, missing your target market, and a potentially costly redesign. Before you begin your website project, make sure you clearly express your business vision, current and future marketing plan, and expectations with your web designer. (BTW- If the web designer isn’t asking you about these vital areas perhaps you should keep looking.)

*Other search engine sources include search engine advertisements, human based search engines or web directories and topical search engines.

Lisa Thayer is owner of, a website design and marketing company located just south of Portland, Oregon. serves clients in 9 states across the U.S. Lisa can be reached at (503) 783-0440 or by e-mail:

Seatbelts Reduce Eye Injury Risk in Auto Accidents

Although airbags in automobiles have helped reduce overall injuries and fatalities by 32 percent since they were introduced in the 1970s, airbag deployment sometimes causes eye injuries, with an estimated incidence of 5 percent. A 2007 study led by Sunil K. Rao, MD, evaluated how seatbelt use correlated with eye injuries and the recovery of visual acuity in auto accidents where airbags deployed. The study concluded that “the use of seatbelts was associated with less severe ocular injuries and better visual outcomes.” Reviewing medical records of the Rhode Island Hospitals general eye clinic January 1997 to August 2005, researchers selected 47 patients who were either the driver or front-seat passenger in an auto accident with airbag deployment, excluding accidents with rollover or ejection. Patients had been questioned by clinic staff regarding seatbelt use, eyewear use, and airbag status.

Injuries were ranked as mild, moderate, or severe using a standardized scale: 49 percent of the patients had severe injuries, 23 percent moderate, 26 percent mild, and 2 percent were not injured. Seventy-one percent of those not restrained by seatbelts had severe injuries versus 31 percent wearing seatbelts. Forty-two percent of restrained patients had only minor injuries. Visual acuity outcomes also depended on seatbelt status, with unrestrained patients significantly more likely than restrained to have 20/200 or worse vision at the three month post-accident follow-up. None of the patients was wearing eyeglasses, and none had previously had cornea transplant or refractive surgery; these variables could influence results in future studies. The patients’ age, gender, accident type and alcohol status were not significantly related to injury severity.

Source: Newswise

Female Vets at Risk of Miscarriage from Anaesthetic Gases and Pestic

Female vets run twice the risk of miscarriage as a result of exposure to anaesthetic gases and pesticides, suggests a study published in Occupational and Environmental Medicine.

The findings prompt the authors to call for young female vets to be more clearly advised of the risks they run, should they want to become pregnant.

The study is based on a survey of women taking part in the Health Risks of Australian Veterinarians Project (HRAV).

This surveyed all those graduating from Australian veterinary schools between 1960 and 2000.

Of the 5700 graduates contacted, some 2800 responded, of whom 1200 were women.

Between them, these women reported a total of 1355 pregnancies, 940 of which occurred while working in clinical practice, and so were eligible for inclusion in the study.

Women carrying out surgery and exposed to anaesthetic gases that were not filtered out of the atmosphere, for an hour or more a week, were almost 2.5 times more likely to miscarry.

Female vets who used pesticides during the course of their work were also twice as likely to miscarry.

And those who performed more than five x rays a week were around 80% more likely to miscarry than those performing fewer procedures.

When the researchers restricted their analyses to those women graduating more recently-between 1980 and 2000-the results were similar.

The authors warn that female vets of childbearing age “should be fully informed of the possible reproductive effects of ionising radiation, unscavenged anaesthetic gases, and exposure to pesticides.”

Women should take protective measures when they are planning to conceive and during pregnancy, they warn. But all staff working in these areas should be aware of the risks and protect themselves accordingly, they suggest.

Source: Newswise


Diagnostic Lab Is Kansas’ First Line Of Defense

Veterinary Diagnostic Lab Is Kansas’ First Line Of Defense Against Bird Flu

If the highly pathogenic strain of avian influenza ever comes to Kansas, diagnosticians at Kansas State University’s Veterinary Diagnostic Laboratory will be the first to know.

The lab, which is part of K-State’s College of Veterinary Medicine, is the first place samples would be tested if there were a suspected case of avian influenza in Kansas.

Dr. Gary Anderson, director of the lab and professor of diagnostic medicine and pathobiology, says that the lab has been certified by the U.S. Department of Agriculture to perform avian flu testing. The lab also tests for swine, equine, and canine versions of influenza.

“K-State’s Veterinary Diagnostic Laboratory is known for thorough and timely diagnostic services,” Anderson said. “And in the case of bird flu, were it to make it to Kansas, time would be of the essence. We presently have five employees who are certified by the National Animal Health Laboratory Network to perform avian influenza testing, which allows handling of a large number of samples and reporting the results within a short time frame.”

Avian influenza was recently in the news because of two pre-Thanksgiving outbreaks in Britain. To date, the pathogenic strain of avian influenza — also referred to as H5:N1 — has been reported in Southeast Asia and a handful of European countries, but not in the U.S. It affects poultry — chickens, turkeys, ducks, etc. — and is particularly contagious among domestic flocks, although the disease is thought to originate with migratory fowl.

“From a poultry standpoint, our biggest concern is that migratory birds from the North will mix in the summer breeding grounds and spread avian flu when they fly south for the winter,” said Scott Beyer, a K-State poultry expert and associate professor of animal sciences and industry. “However, this has not yet happened in North America, which is somewhat of a surprise.”

According to Beyer, if the bird flu does make it to the United States, poultry producers are prepared and have been taking precautions against the disease for some time.

“The chicken and turkey industries screen all flocks for avian influenza prior to sending them to the processing plant,” Beyer said. “For many years, the U.S. policy has been never to allow any form of avian influenza to persist in the birds. So, even the most benign form is not allowed to exist in flocks. If we do have an H5:N1 outbreak, which is the highly contagious kind, our system would pick it up very quickly.”

If a producer or member of the public sees a sick bird or birds, Kansas State also manages the Avian Influenza Hotline at 1-800-566-4518. The hotline is a cooperative service provided by the Kansas Department of Health and Environment and the Kansas State Veterinary Diagnostic Laboratory. All questions concerning dead birds or birds that appear to be sick can be referred to this number.

Typically, a single dead bird should not cause significant concern, Anderson said. “We start to worry when there is a large group of dead birds or migratory waterfowl in a relatively small area,” he said.

Anderson encourages anyone with questions to call the hotline so the veterinary professionals manning the phones can help determine whether the death or sickness is an indicator of serious disease.

Source: Newswise

From the Editor

I hope you find this issue as informative as previous issues and I hope to continue to give you the most recent up to date articles on health care and management concerns.

In this issue, there is a profile on Dr. Vincent Dolce, DMD of Palm Beach, Florida written by former National Geographic TV producer, Chuck Friedman. Chuck was in the middle of creating a documentary on community leaders and the qualities of leadership when he discovered Dr. Dolce. You should find this to be a very informative article.

Lisa Thayer, co-owner of, returns with the second part of a four-part series on search engine marketing. This is a very interesting article that delves more deeply into the often mysterious world of making yourself known on the Internet.

An article profiling a different Florida dentist, Dr. Lee Sheldon and his charitable activities, has also been added. It contains some excellent ideas on how you can use community outreach to boost the profile of your medical practice whether you are a dentist, optometrist, veterinarian or any medical professional.

In addition, we have our usual complement of profession-specific news stories and our regular practice management articles that you can use right now to benefit your practice.


Cory D. Radosevich

The Practice Solution Magazine

Managing Editor

Guide For Veterinarians

Includes Unusual Species Adopted Into Human Households And Potential Hazards To Human Health

Ferrets, frogs and finches are becoming more common as pets, but the list of unusual species adopted into human households now includes some of the most exotic creatures on the planet. The trade in exotic pets has become a multi-billion dollar enterprise, but expansion of the industry sometimes outpaces veterinary knowledge of how to treat the maladies that afflict these unusual animals.

The new “Manual of Exotic Pet Practice,” published by Elsevier and edited by veterinary experts at the University of Illinois and Louisiana State University, provides detailed information on all of the major exotic animal groups. The book devotes entire chapters to invertebrates, ornamental fish, amphibians, crocodilians, snakes, lizards, chelonians (turtles and tortoises), birds, marsupials, ferrets, rabbits, hedgehogs, chinchillas and guinea pigs. Rats and mice get a chapter, as do hamsters and gerbils. A final chapter offers guidance on the treatment of injured wildlife.

“We felt that there was a strong need for a general exotic pet textbook that could be used by veterinarians to manage any exotic animal that came their way,” the editors wrote in the preface.

University of Illinois wildlife veterinarian Mark A. Mitchell co-edited the book with LSU professor of zoological medicine Thomas N. Tully Jr.

The manual includes a brief history of the age-old tradition of capturing or domesticating wild animals, and a chapter on how to prepare an animal hospital for exotic pets. Each of the other chapters lists common species kept in captivity, and offers guidance on their biology, husbandry, nutritional needs, preventive medicine, common diseases, and potential hazards to human health.

Want to know how to restrain a crocodile so you can give it a proper exam” How do you know if a turtle is suffering from a vitamin A deficiency” Is the lethargic rabbit in your waiting room a victim of heat stroke or cardiac disease” Did that frog swallow something it shouldn’t have” The book offers guidance on these and myriad other potential therapeutic challenges.

Diagnostic approaches and treatment strategies are described in every chapter, and each includes information about surgery and, when applicable, special instructions related to anesthesia.

The book includes hundreds of color photographs of the maladies and injuries that sometimes afflict exotic animals, with more photos of common examination and treatment techniques. An in-depth index allows quick reference to items of interest.

“Dr. Tully and I were interested in pursuing this book because we saw a real need for an ‘all-exotics’ text for the general practitioner,” Mitchell said. “Historically, veterinary texts for exotic pets have been group-specific (for example, devoted entirely to reptiles or birds). Although invaluable, many veterinarians have expressed a desire to have a single point, primary reference to obtain clinical information on these animals. We hope this text will serve the tens of thousands of veterinarians managing exotic pet and wildlife cases as an invaluable resource to manage their patients.”

Source: Medical News Today


Are Cataract Rates Declining?

The population-based Beaver Dam Eye Study was designed by Barbara E. K. Klein, MD, MPH, and colleagues to determine through long-term observation whether there were differences among age cohorts regarding rates of cataract prevalence and surgery, as well as type of cataract. Five thousand residents of Beaver Dam, Wisconsin were examined for the three most common forms of cataract-nuclear, cortical and posterior sub-capsular—at baseline in 1990 and five, 10 and 15 years later. Results were analyzed by age group and gender for this population, which was 99 percent white. The rates of all three cataracts increased with age for all cohorts and are described in the study in detail by age cohort and gender.

An interesting decline in prevalence of nuclear cataract—the type characterized by hardening of the center of the eye’s lens—was found when participants were considered in five-year age and birth cohorts (excluding the 75+ group, which had too few participants). Even after adjusting for expected higher prevalence at older ages, the study found that prevalence declined in each successive birth cohort. The authors suggested that this decline may be related to negative health habits shared by people in the older cohorts and to more positive health habits in the younger cohorts. The researchers write: “Possible protective exposures include a decrease in smoking and increase in exposure to healthy lifestyle habits.” Rates of cataract surgery also increased in the 15-year time period, as surgical techniques and outcomes improved significantly and more people elected cataract surgery at earlier points in the disease process.

Source: Newswise