Presenting the Patient Lecture (Dr. Cox) Flashcards
General Notes of Presenting
- Presentations reflect your development and experience
a) Less detail being required as you progress
Preparing for Presentation
Four this to CONSIDER BEFORE you do you Oral Presentation:
1) Message
2) Audience
3) Purpose
4) Occasion (Setting and Circumstances)
Preparing for Presentation
Be prepared to answer the following questions about…
1) Etiology
2) Pathophysiology
3) Diagnosis
4) Complications
5) Differentail Diagnosis
6) Course of Conditions
7) Treatment and Techniques
8) Diagnostic Tests
9) Curent and Past Medications
Preparing for the Presentation
Other Measures to take
- PATIENT EVALUATION:
- History, examination, review of tests, studies, procedures, and Consultant recommendations - SELECTED READING:
- Reference texts- to build a FOUNDATIONAL Understanding - LITERATURE RESEARCH:
- For clarification of any key references, and to bring your understanding “up to date” - WRITE UP (NOTES):
- For Oral Presentation, just key information to serve as a reminder or reference, since you’re not going to be reading your presentation
How to Present a Patient
- Many variations on this theme
- Inpatient vs Outpatient
- Varies by specialty, attending:
a) FM: Ms Smith is a 23 y/o female who presents with…..
b) FM: Ms Smith is a 23 y/o Hispanic married mother of two…
c) OB: Ms Smith is a 23 y/o G3P2….
d) Ortho: Ms Smith is a 23 y/o right-handed typist….
How to Present a Patient
Common Requirement:
- Be Succinct and Logical
- Present from MENTAL TEMPLATE
a) DO NOT Read From Notes
b) Fill in the Boxes in your Mental Template
Type of Presentations
1) New Patient
2) Follow up
3) Bedside
Types of Patient Presentation
NEW PATIENT
- Traditional H & P with assessment and plan
a) Remember, Attending PREFERENCES exist - Give the Chief Complaint and pertinent HPI
- Important PMH, PSH, etc.
- The ROS is often left out
a) Incorporate into HPI - PE-give PERTINENT Positives and Negatives
- The ASSESSMENT and PLAN should include what you think is wrong, WHAT you want to do about it, and WHY
Type of Patient Presentations
FOLLOW- UP
- Patient’s Name, Age, Date of admission or hospital day #, postop day #, etc.
- Recap Major patient ISSUES that have been previously presented (requires chart review) and what has changed
- Briefly REVIEW the present Illness, Physical Exam and Diagnosis
- Report any NEW FINDING, Laboratory Tests, Diagnostic Procedures and CHANGES in meds, assessment and plan for the day
Types of Patient Presentations
BEDSIDE
- The Attending physician will ASK the Patient’s PERMISSION to have the medical student present their case
- After making the Proper Introductions the attending will let the Patient KNOW they may OFFER Input or ASK Questions at any point
a) When presenting at bedside the student should INVOLVE the Patient
Basic Template for Oral Presentation
1) Patient Description
2) Chief Complaint/ History of Chief Complaint
3) Pertinent Review of Symptoms
4) Pertinent Medical, Social, and Family History
5) Physical Exam
6) Labs and Tests
7) Assessment and Plan
Template for Oral Presentation
CHIEF COMPLAIN
- The opening statement should give an OVERVIEW of the Patient, Age, Sex, REASON for Visit and the Duration
- If your patient has a HISTORY of a MAJOR Medical Problem that bears strongly on the Understanding of the present illness, include it
- For ONGOING CARE, give a One Sentence RECAP of the history
Template for Oral Presentation
Starts with HPI
O, L, D, C, A, A, A, R, T, S
HPI- Cold Read:
- Character
- Onset
- Location
- Duration
- Radiation
- Exacerbation
- Alleviate
- Different Today
Template for Oral Presentation
HISTORY OF PRESENT ILLNESS (HPI)
- Very similar to your Written HPI
- Present the MOST IMPORTANT PROBLEM FIRST!!!!!!!!
- If there is more than One Problem, Treat Each SEPARATELY
- Present he Information CHRONOLOGICALLY!!!!!
- Cover one system before moving on
- When you do you first Patient Presentation you may be expected to GO INTO DETAIL
- ONGOING CARE, Present Changes and NEW Complaints
Template for Oral Presentation
PAST MEDICAL HISTORY, PAST SURGICAL HISTORY
- CHRONIC Diseases: DM, HTN, Cancer, COPD, Heart Failure
- Previous Hospitalizations
- INFECTIOUS Diseases: Rheumatic Fever, Polio, TB, Measles, Mumps, Hepatitis
- IMMUNICATIONS: Are they Current, if adult last Flu and Pneumonia Vaccines, Tetanus, PPD
- HEART MAINTENANCE: Screening Tests that are applicable for Age-Colonoscopy, Mammo, PAP Smear, Etc
- SURGERIES
