Any general tips on how to more efficiently present a patient?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

sharklasers

Full Member
Joined
Jul 26, 2012
Messages
483
Reaction score
4

Members don't see this ad.
General tips on how to organize things, what to say when, etc.

I know it mostly depends on the patient, but just any semblance of a structure i could follow would be super helpful.

Thanks :)
 

Rendar5

Full Member
15+ Year Member
Joined
Nov 12, 2003
Messages
7,056
Reaction score
779
XX is an 45 year old man/woman who presents with 3 days of fever and back pain.
Then give your HPI on one chief complaint at a time.
In the review of systems, patient also complains of nonproductive cough, congestion, and nausea
XX has a history of (PMH list goes here)
(If any PMH is pertinent to the complaint you can expound on it more).
He's also had appendectomy/cholecystectomy/orchiectomy/spinal fusion (y years ago)/etc
His family history is noncontributory.
In terms of social history he's a 20 pack-year smoker, drinks 8 beers a day, has a history of IVDA, and lives alone
In terms of the physical:
His vital signs are normal except for a temperature of 100.7 and a HR of 108.
Pt is A&Ox3 and appears uncomfortable
HEENT is normal
lungs are clear
abdominal exam is normal
cardiac exam is regular tachycardia, with a 3/6 holosystolic murmur at the apex
Back exam is notable for midline ttp in the upper lumbar spine.
The remainder of the exam, including mental status and neuro exam is normal.

The assessment and plan is next and depends on what field you're in how you'd present it. That is a generic structure up there though of age/gender/CC followed by HPI, followed by RoS/PMH/PSH/FH/SH. Then physical exam with vitals first, then pertinent positives and negatives. If testing has been done already, you can then summarize labs, imaging, and ancillary testing. if it hasn't been done, you'd address it in the A/P.
 

HumorMD

New Member
Joined
Sep 20, 2012
Messages
4
Reaction score
0
Above template is good. Remember that every attending likes different things. I usually ask the first time I present to someone along the way if they want to hear everything etc. For example, I only explain pertinent positives/negatives in the physical exam unless they want to hear it all. You will never do it the first time exactly like they want. Expect to get interrupted and corrected no matter what level you are. Smile, do it their way, and move on with life.
 

theshellyb

Full Member
10+ Year Member
Joined
Aug 25, 2010
Messages
327
Reaction score
60
Also, make sure you're aware of your verbal tics, and try to correct them. The medical student who can get through the entire presentation without saying "um" sounds infinitely more professional/together than the student who says "um" every 4th word, even if they ultimately present the same information.
 

joshua201

New Member
10+ Year Member
5+ Year Member
Joined
Jun 24, 2008
Messages
8
Reaction score
0
XX is an 45 year old man/woman who presents with 3 days of fever and back pain.
Then give your HPI on one chief complaint at a time.
In the review of systems, patient also complains of nonproductive cough, congestion, and nausea
XX has a history of (PMH list goes here)
(If any PMH is pertinent to the complaint you can expound on it more).
He's also had appendectomy/cholecystectomy/orchiectomy/spinal fusion (y years ago)/etc
His family history is noncontributory.
In terms of social history he's a 20 pack-year smoker, drinks 8 beers a day, has a history of IVDA, and lives alone
In terms of the physical:
His vital signs are normal except for a temperature of 100.7 and a HR of 108.
Pt is A&Ox3 and appears uncomfortable
HEENT is normal
lungs are clear
abdominal exam is normal
cardiac exam is regular tachycardia, with a 3/6 holosystolic murmur at the apex
Back exam is notable for midline ttp in the upper lumbar spine.
The remainder of the exam, including mental status and neuro exam is normal.

The assessment and plan is next and depends on what field you're in how you'd present it. That is a generic structure up there though of age/gender/CC followed by HPI, followed by RoS/PMH/PSH/FH/SH. Then physical exam with vitals first, then pertinent positives and negatives. If testing has been done already, you can then summarize labs, imaging, and ancillary testing. if it hasn't been done, you'd address it in the A/P.

This format is a great one. Getting familiar with the case would be useful also as you will be more fluent
 

neusu

Full Member
Moderator Emeritus
10+ Year Member
Joined
Feb 13, 2012
Messages
1,692
Reaction score
1,943
XX is an 45 year old man/woman who presents with 3 days of fever and back pain.
Then give your HPI on one chief complaint at a time.
In the review of systems, patient also complains of nonproductive cough, congestion, and nausea
XX has a history of (PMH list goes here)
(If any PMH is pertinent to the complaint you can expound on it more).
He's also had appendectomy/cholecystectomy/orchiectomy/spinal fusion (y years ago)/etc
His family history is noncontributory.
In terms of social history he's a 20 pack-year smoker, drinks 8 beers a day, has a history of IVDA, and lives alone
In terms of the physical:
His vital signs are normal except for a temperature of 100.7 and a HR of 108.
Pt is A&Ox3 and appears uncomfortable
HEENT is normal
lungs are clear
abdominal exam is normal
cardiac exam is regular tachycardia, with a 3/6 holosystolic murmur at the apex
Back exam is notable for midline ttp in the upper lumbar spine.
The remainder of the exam, including mental status and neuro exam is normal.

The assessment and plan is next and depends on what field you're in how you'd present it. That is a generic structure up there though of age/gender/CC followed by HPI, followed by RoS/PMH/PSH/FH/SH. Then physical exam with vitals first, then pertinent positives and negatives. If testing has been done already, you can then summarize labs, imaging, and ancillary testing. if it hasn't been done, you'd address it in the A/P.

"Normal" is not going to cut it on physical exam. Pertinent positives and negatives e.g. "abdominal exam is normal" would be "abdomen soft, nontender, nondistended with normactive bowel sounds."


FWIW being able to develop a 1-liner is important and the format is relatively simple.

[age] y/o [sex] presents w/ [chief complaint] for [duration of onset] and associated history of [pmh] managed with [relevant home meds].
[brief exam findings]
[relevent labs]
[relevant imaging]
Assessment: [age] [sex] with [primary dx]
plan:
for initial evaluation: [admit/obs/discharge] [condition] [vitals frequency/requests: hr/bp/uop/saO2] [activity] [nursing orders] [diet] [access] [labs] [imaging ] [special orders ] [meds]
for f/u evaluation: [status: stable/improved/worsened] [med changes] [additional labs/imaging] [disposition]
 

ArcGurren

only one will survive
Joined
Aug 6, 2010
Messages
1,920
Reaction score
15
All of the above examples are excellent. The problem is that it's tough to have a single standard way of going about this because it varies depending on many things, including

- Rotation - for medicine I typically had more detailed and longer presentations (never exceeded more than 5-10 minutes though), for surgery my presentations were typically < 5 minutes. For OB it depended a lot on the service. My neuro presentations on the other hand were quite long because describing physical findings took quite a while (10-15 minutes... thank god we had a light load that month).

- Attending - even within certain fields you'll have different preferences amongst attendings. I had some very unreasonable medicine attendings who wanted specific details about every bit of past medical history (for example, PFT results if they had COPD, specific percentages of blockages if they had CAD, etc) while I had some medicine attendings who wanted a much much more focused presentation. I think typically the older attendings prefer a more detailed presentation and the younger ones across almost all fields tend to prefer shorter presentations.

So yeah. Short answer, it depends a lot.
 

Rendar5

Full Member
15+ Year Member
Joined
Nov 12, 2003
Messages
7,056
Reaction score
779
"Normal" is not going to cut it on physical exam. Pertinent positives and negatives e.g. "abdominal exam is normal" would be "abdomen soft, nontender, nondistended with normactive bowel sounds."


FWIW being able to develop a 1-liner is important and the format is relatively simple.

[age] y/o [sex] presents w/ [chief complaint] for [duration of onset] and associated history of [pmh] managed with [relevant home meds].
[brief exam findings]
[relevent labs]
[relevant imaging]
Assessment: [age] [sex] with [primary dx]
plan:
for initial evaluation: [admit/obs/discharge] [condition] [vitals frequency/requests: hr/bp/uop/saO2] [activity] [nursing orders] [diet] [access] [labs] [imaging ] [special orders ] [meds]
for f/u evaluation: [status: stable/improved/worsened] [med changes] [additional labs/imaging] [disposition]

If you want to get technical, you can mention every vital sign and every pertinent positive and negative for every single section of the physical exam. It's all going to depend on the rotation. For some, "normal" will suffice once you've proven you know how to do a thorough exam. For others, you're correct, you'll need to use a one liner for every pertinent organ system. When in doubt, do as neusu suggested.
 
Top