Presenting Surgical Cases?

[indieboy117]

Anyone know a website/page that would help me present a surgical case properly? I'm well aware on how to take the general inquiry, history, and do both the general and local examinations. I have trouble putting my findings in the a quick yet meaningful format.

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[deleted87716]

This link was just posted in another thread: http://medicine.ucsd.edu/clinicalmed/oral.htm

 

[Winged Scapula]

The above link as the most important point for ANY presentation (in business, medicine, etc): know your audience.

For example, when presenting a patient to a surgeon, we are most concerned with Is and Os, fevers, pain control, wound appearance (if appropriate), and the appropriate system exam (ie, in a patient with diverticulitis, what is the abdominal exam). We don't care so much about the neuro exam (unless there is something acutely wrong which needs a consult) or irrelevant social history.

OTOH, to use an example of my own last week (and the student in question will probably be embarassed to read this ); while working on medical oncology, I really don't want to hear details about the wound, only that she's x days post-op, doing well and then details about the pathology (which may guide my treatment plan).

So, know your audience, know the system of concern (that should be your focus), don't belabor points (or you'll get taken down a path in which you won't know the answer) and like for any presentation, have a wrap up summary and plan. It is NOT okay to say, "looks good from door" (unless you are on an Ortho rotation).

 

[Dr JPH]

It is NOT okay to say, "looks good from door" (unless you are on an Ortho rotation).

 

[Bubb Rubb]

The above link as the most important point for ANY presentation (in business, medicine, etc): know your audience.

For example, when presenting a patient to a surgeon, we are most concerned with Is and Os, fevers, pain control, wound appearance (if appropriate), and the appropriate system exam (ie, in a patient with diverticulitis, what is the abdominal exam). We don't care so much about the neuro exam (unless there is something acutely wrong which needs a consult) or irrelevant social history.

knowing your audience on surgery often means saying less. my presentations were often of this style (much more terse than the layout in the internal med-biased link):

mr. xyz is a N-year old male, post op day M following procedure blah. overnight events: afebrile, tolerated clears without nausea or vomiting, ambulated 3x. vital signs within normal limits except for this, that, and the other. ins are eleventybillion liters greater than outs, with 500 cc of this being foul smelling emesis with green seamonkeys swimming around in it. he used A mg out of B possible mg on his PCA. PE is notable for [insertfindingshere]. cultures show he has the superAIDS and anal SARS, no new cultures pending. labs from this morning are unremarkable except for ____. in summary this is a N-year old male pod M doing [well,poorly,intermediatestateyetundefined]. by systems:

and then go down the list: neuro, pulm, cv, gi, gu, id, heme/dvt, endocrine, fen. consult with your chief on whether she/he wants the whole plan for each system, just what you think should change, or just 5 words total ("is the patient ok? yes. ok, next patient...")

 

[Winged Scapula]

...foul smelling emesis with green seamonkeys swimming around in it.
...

"why are you wasting my time telling me about green seamonkeys? I they're not red, I don't care about them!"

 

[Winged Scapula]

...consult with your chief on whether she/he wants the whole plan for each system, just what you think should change, or just 5 words total ("is the patient ok? yes. ok, next patient...")

I preferred even less..."Is he/she alive? Ok, move on."

or

"Exam A? (NB: everything status quo/unchanged for patient)"

 

[deleted87716]

cultures show he has the superAIDS and anal SARS...in summary this is a N-year old male pod M doing [well,poorly,intermediatestateyetundefined].

Yeesh...I'm voting for "poorly," in that case.

 

[deleted87716]

I preferred even less..."Is he/she alive? Ok, move on."

or

"Exam A? (NB: everything status quo/unchanged for patient)"

Triple point.

 

[ericdamiansean]

One more thing, how about what should be written in the notes?

I've heard many consultants berrating junior doctors for writing nonsense or just repetition eg:
Seen by: Dr X (12pm, 21st February 2007)

Temp: 37 C
RR: 18
PR: 68
Patient looks well
Plan: Continue management

The same thing gets repeated, until something "interesting" happens to the patient

Some went to the extent of tearing off the pages and asking for a rewrite

 

[dynx]

One more thing, how about what should be written in the notes?

ID. Mr. X 56yo male s/p _____-ectomy pod 2
24hr events: tol PO, +BM etc
Hpi of any new complaints
Vitals: with I/Os by route or drain
Exam: I write, resp CTA, CV RRR, wound if applicablt, exam unchanged from previous
New imaging
A/P

I keep a running list of medications in the top corner, why? I don't know, Id never trust a chart list anyway. I think its mostly so attendings can b*tch about it on rounds.