Anxiety when presenting patients

[Squirmish]

As the title suggests, I have bad anxiety when I'm presenting my patient during rounds. It frustrates me so much because I sound and look stupid. I had no problems presenting patients to attendings when I was in a clinic because it was just me and the attending and perhaps a student and a nurse nearby. But when there's 6 or 7 of us during rounds, I just freak out for some reason. I don't know why.

I don't have problems giving speeches like in a lecture setting. Heck, I used to teach Kaplan MCAT classes so I don't have problems standing up in front of a large group of peers. But there's something about the intimate setting of rounding that makes me anxious. Incidentally, I had problems in PBL for the same reason.

When I'm presenting during rounds, my face turns beet red, I start stumbling over words, omitting pertinent information, etc. God, it's so stupid because I have it all organized on my piece of paper but I sound so ill-prepared when I present it.

Any advice?

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[SF_Hopeful_MD]

I know what you mean. It can be stressful at times. I think it just takes practice. Also it helps to know your patient really well. If you have cool residents, see if you can present to them first and have them correct anything you may be saying that sounds wrong or is unnecessary.

Another thing, try to think about what the attending wants to hear. If the person is post-op from an abdominal procedure start your presentation with any events since the morning before and how the patient is feeling with regard to that procedure. For the physical exam presentation start with the status of the abdomen, the pain, any wound dehiscence, bowel sounds, bowel movements, flatus etc. Then move on to other less pertinent things.

Assessment & Plan is the most important part of your presentation so after you round on your patients, sit down and make a problem list and really think through what you would like to do for each problem on the list. Be able to back it up with your reasoning.

Hope this helps.

 

[JasonUD]

Any advice?

propranolol 10mg po q1hr before signouts PRN

 

[Tiger26]

Photocopy or print out your progress note or H&P before you present rather than just going off memory or random notes you took. This will give you the organization that they're looking for and you an escape to look down quickly and read it off if you can't remember a detail or get flustered.

I felt the same way you did until about halfway through 3rd year until I started copying my note before presenting. Given that your H&P and presentation comprise a significant amount of an attending's opinion of you, doing it well can really have a huge impact on your grade.

Over time you'll get better to the point where you can go off memory or a couple of notes.

 

[The Angriest Bird]

propranolol 10mg po q1hr before signouts PRN

/cosign

 

[sunshine04]

Ditto the above. I take propranolol and photocopy my notes. I also keep a photocopy of the admit note and notes for a couple days back around, in case I get asked to follow up on slightly older information. I'm right there with you on the nerves. Just coming off of a rotation that was very laid-back, no formal rounds, just two students and the attending etc to a big team where I have to bind and torture the interns just to get basic information about my patients.

 

[nope80]

I'm so glad I came across this thread - I have the same problem, but maybe worse. My heart races when I start giving presentations to the point that I feel like I can't even talk. I talked to my doc and he prescribed propanolol 20 mg - he said do it half an hour before the presentation. Would you do 1 hour before or half an hour before? How much does it help? Pure relief or do you still experience some symptoms. Also how often do you guys take it?

 

[tfom08]

What do you guys plan to do as far as coming off of the propranolol? Are you going to taper it at some point? I mean, I've been nervous when presenting patients before, especially the first couple of times, but eventually you get used to it and it's like talking to your parents at the dinner table or something. People use propranolol if they get nervous before big presentations at work now and then, but we are probably going to be presenting patients 5-10 times a day or more for the next 4-5 years as students and residents. I don't think I would like to walk around Beta-blocked all day.

 

[J ROD]

Beta-blocked!

Learnt me a new word, haha!!


Just go off a progress note or make a note yourself that is organized with all the pertinent stuff. Personally, I think less is more. Not everything is pertinent but also take into account what your attending wants. Some want it all and some want the bare minimum.

You could also ask the interns for help.

 

[jtlc2345]

I've found that when presenting on 'business rounds' where the attending only wants the essential info, using SBAR really helps to focus down my presentation to the bare minimum and shows that you are able to make that step up from information gatherer to intelligent user of that information.

Jonathan

 

[McGillGrad]

Only thing that works is practicing the presentation a dozen times in front of the mirror

Then it is all about habit...no thinking required to screw you up

 

[JStub]

Photocopy the note and read it. Some attendings don't like that but it may help you and well, that's just the way you present. I don't think you'd get graded poorly because you look down and present off the note.

 

[elephantrosie]

PHOTOCOPY our own notes? WHY??

 

[nightowl]

I have always had anxiety problems while presenting as well, pretty much my entire third year. Even now, I hate presenting patients on rounds. I never used propranolol, but I ALWAYS have a photocopy of my note, the H and P on hand, which I read over before rounds so that I remember the initial presentation and initial labs and stuff. The reason why photocopying your own note works so well is bc all the information is there, it's all organized, has all the pertinent info (labs from that day, vital signs, etc) and if you forget what the plan is for that day, you have it right there on your note. Ideally you won't have to read off of it at all, except for vitals, but anyone with major public speaking anxiety knows that you can forget EVERYTHING when you're nervous, even if you really know your patients. I will say that it does get better after a while. It's not like they can physically harm you or anything. Just remember that when you feel like they're about to eat you for lunch.

 

[Deferoxamine]

Anxiety? No.

But I'm starting to get worried that my current attending could be analyzing my method of presenting patients. My attending last month loved the fact that I was energetic, quick-thinking, detailed, and spitting out 500 words per minute. I'm realizing that my current laid-back "eh, whatever" attending probably thinks I'm just this obsessive anal Type A nerd walking around spewing out factoids that he doesn't even care about.

Oh well.