Show me an MS3 who thinks they can spew out a detailed, correct assessment and plan with no help from me or anyone else, and I'll show you an over-arrogant student with a big surprise coming up on his or her eval. Seriously, you shouldn't feel bad at this stage about not knowing the next step. The important thing is to push yourself to try. Do the information gathering, and then leave 2-3 minutes after you leave the room (or before if your preceptor hangs around outside the door) to quickly think about or look up the patient's problem. You could use UTD or diagnosaurus, or run through the VINDICATE categories. If you get nervous when you get to that section during the presentation, think of a basic template you can run through in your head:
1. pt age, pertinent PMHx and CC
2. 2-3 top likely causes
3. 1-2 rare but potentially life-threatening causes
4. w/o for above-- think about labs, rads
5. treatment for above (even basic suggestions... antibiotics? steroids? joint injection?)
6. treatment of symptoms (general categories: treat pain? needs work note?)
7. when to follow up
If you even come up with a just few words for each of the above, that's actually a lot. If you're off base or have no idea what the treatment is, now is your opportunity to learn! Here's an example:
54 y/o with past MI, here with non exertional left chest pain after trauma, now resolved. The description sounds most like musculoskelletal injury, but GERD is also possible and it would be important not to miss a cardiac source. We could get an EKG and CXR in the office today, make sure he's taking all his cardiac meds, and suggest acetaminophen for pain. If it doesn't resolve he should come back in 2 weeks, and if it gets worse or he gets short of breath or diaphoretic with the pain he should go to the ED.
Hope that helps.
