CS Advice

[ephman90]

Took CS on 2/22/08 in LA...Was really worried after that stupid thing, but now that I passed, I want a refund and I thought I would offer up my 2 cents considering this POS is often the last thing standing in the way of the ol' MD...Learn a mnemonic system and stick with it throughout the whole exam. The one I used was FORDPAPPLIQR (Freq, Onset, Relieving, Duration, Previous episodes, assoc symptoms, precipitating factors, I forget the other P, location, intensity, quality, radiation.) Before I went into each room, I would look at the info on the door, write out the mnemonic vertically and then Fam H, PMH, PSHx, Meds, Allergies and social Hx. I would also write out a short DDx and any pertinent ?'s or procedures I would want to do/ask so I wouldn't forget later. The whole deal took me about 45 seconds to do before I went in, but it payed off big time. I forgot to do this on my 1st SP and was really flustered in there. People rush in 2 secs after they let you look at the info and I think this is stupid. Take your time, compose yourself and go in with a plan. As far as the physical goes, I did heart, lungs, abdomen on everyone. I offered up treatment plans on all smokers/drinkers, CAGE for every drinker. If they seemed sad SIGMECAPS. Performed orthostatic vitals on a guy with near syncope (forgot to do a neuro on him...oops). I wore gloves the whole day b/c I thought it was faster. The day goes by pretty fast. Be nice to the SPs, look them in the eye, answer their difficult question, summarize before your physical and then give them a potential diagnosis or two and let em know that you need to run more tests to be sure. I read FA for a couple of days and found it to be really good with solid advice. Good luck...

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[ssg]

Thank you for the advice. Much appreciated.

 

[medblazer21]

I agree in general with your advice, with one exception. I wouldnt do a routine heart/lung exam on everybody unless you know for sure you have extra time and have done everything else (which should be rare, even the extensive number of history questions you need to ask each patient).

For example, on a dizziness patient you should never ever do a lung exam because bottom line is that you wont have enough time to do that without missing something else thats more important than listening to the lungs.

Doing a full neuro + heart exam in a dizziness patient doesnt leave much time for anything else.

However, that being said I absolutely agree with your mnemonic strategy and standing outside hte room to write notes before you enter the room. I think thats extremely helpful and I dont understand everybody rushing into the room. Spend up to 1 minute outside hte room writing down a diff dx, LIQORAAAFPPPT, PAMHUGSFOSS, TOADDESS before going in. It will feel weird at first being the only one out there while everybody else rushes in, but trust me it will pay off.

 

[NuMD97]

It will feel weird at first being the only one out there while everybody else rushes in, but trust me it will pay off.

I agree 100% about spending time with the doorway information. I, too, felt a tad ill at ease watching everyone fly in, while I was still writing the mnemonic and the data, even the name of the patient, so I could address him/her by name. It truly is time well spent.

Nu