How to present pt to mean attending!!!

[heathermed]

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Hello...

I just began my IM rotation and my attending is really mean and doesnt try to teach me anything! I understand that they're really busy, but every time I present a patient and even before I finish 1 paragraph, she just goes like "you need to learn how to present before you come in front of me" and then tells me to stop and asks the intern to present the patient instead. This has happened 3 times in a row. I keep making changes in my presentation but I still keep getting the same response.

I start off with:

pt is a XXyo AAF/CF/etc with a history of XX who presented to the XX with (insert chief complaint here).

After this is where I think I screw up because whatever I say after this, I get cut off.

so can someone please help me on how to present a patient in IM. I tried reading alot of the notes that I school provides, but I'm still not getting anything.

thank you very much,
I would really appreciate it

 

[a winner is you]

So why don't you actually listen to how the intern presents and see what the attending wants? If it's happened 3 times at the exact same spot and you still don't get it, that pretty much just means you're a *******.

 

[Droopy Snoopy]

So why don't you actually listen to how the intern presents and see what the attending wants? If it's happened 3 times at the exact same spot and you still don't get it, that pretty much just means you're a *******.

What crawled up your ass?

 

[Scaredshizzles]

Hello...

I just began my IM rotation and my attending is really mean and doesnt try to teach me anything! I understand that they're really busy, but every time I present a patient and even before I finish 1 paragraph, she just goes like "you need to learn how to present before you come in front of me" and then tells me to stop and asks the intern to present the patient instead. This has happened 3 times in a row. I keep making changes in my presentation but I still keep getting the same response.

I start off with:

pt is a XXyo AAF/CF/etc with a history of XX who presented to the XX with (insert chief complaint here).

After this is where I think I screw up because whatever I say after this, I get cut off.

so can someone please help me on how to present a patient in IM. I tried reading alot of the notes that I school provides, but I'm still not getting anything.

thank you very much,
I would really appreciate it

First of all there is no right way, it is really attending dependent..Some want the full story every time you present, some want the bare minimum of new issues that need to be addressed today with the patient...Second of all, you should see if presenting the same way the intern is doing helps in terms of attending response. It might, but it might not for two reasons----attendings sometimes expect different types of presentations from students and interns (more through in the case of students, more practical in the case of interns)...and sometimes attendings simply feel it their duty to put down students no matter what they say..(some will feel the duty to put down residents no matter what they say---although this makes life more difficult for the attending because they have to work with and depend on the same residents for a longer period of time.) Thirdly, don't take the rudeness to heart---anyone who criticizes without in any way being educational in their critique and pointing out exactly what to do to improve is a very poor teacher and shouldn't be a teaching attending in the first place.

 

[Winged Scapula]

How about asking the residents for some insight? They surely know her and what she wants.

Failing that, how about manning up and asking the attending? Something like, "it appears that you are unhappy with my performance and I really want to do well on this rotation, etc. Perhaps you could help me do better and let me know what I could improve upon?"

 

[cpants]

Compare the first line of the intern's presentation to the first line of yours. See what is different. She probably is looking for more of a situational presentation b/c she is aware of the pt's history. Tell her about new developments with the patient, new labs/exam findings, your assessment and plan. Presentation should be no more than 90 seconds.

 

[metallo]

Some very good advice so far... I would agree that you should try to model your presentation after the interns' presentations. If that fails, definitely talk to your attending. Ask for feedback! I'm on my first rotation right now, and I had read somewhere (maybe First Aid for the Wards, but I'm not positive) that you should ask an attending or senior resident for feedback about halfway through your time with them. This has paid off remarkably well for me so far. We get to see our evals as they roll in, and one attending actually wrote that he was impressed that I asked, that it's very rare for students to do so, it showed initiative, yada, yada, yada.

As an aside... your attending kinda sounds like a beeyotch. She should take the time to go over how to give a presentation with you if she wants it done a certain way (all the more reason to ask for feedback... it sounds like it couldn't hurt at this point anyway).

 

[Doctor Bagel]

Wow, sorry! Her attitude sucks, especially considering this is probably your first rotation, where you're supposed to learn how to present. It sounds like you're doing it the way that normally works in IM, but yeah, attendings have their own little things that they want. I agree with the advice above about listening to what the interns do and copy that. If that doesn't work, then ask her for advice. I suspect she'll blow you off because she sounds pretty evil, but what else can you do?

Also, the problem might be more related to your tone of voice than to what you're actually saying. If you don't sound confident, she might assume you don't know what you're doing. Anyway, I'm sorry you're having such a bad experience at the start of your 3rd year. I'd be sure to mention that in your evals.

 

[jdh71]

You cannot help what the attending does, so I'd present formally, until you are told to do otherwise. There is a chance you will not be able to please this attending, ever (some people suck).

Generally, the attending will know plenty about the patient and case, so don't present a mini-HPI (not helpful) . . . do it this way:

Identify the patient and comment on why they are here, or possibly still here (Mr. Smith is a 55 y/o male admitted with pneumonia)

Then go into your subjective: start with acute events if any, then let the attending know about any important scans/tests since rounds yesterday, and if the consultants you asked have stopped by, finish with your daily pertinent ROS (Mr. Smith attempted to get out of bed last night and fell, but did not hit his head, focal neuro exam by on-call demonstrated no deficits, this morning patient is denying and SOB, fever, chills, or sweats)

Next vitals, and exam - as a student, you should probably give them your exam of ALL of the main systems: general, CV, pulm, ab, and extremities

Then Labs and other tests

Finally your assessment and plan

You can't go wrong this way - your house staff will let you know, or they should, if you can cut back on any of it.

 

[OncoCaP]

Find some interns and residents to practice with, preferably before you give it to the attending. They usually have pretty good advice. It's not easy ... like learning to riding a bike, I suppose. You fall down many times before you learn to talk fast so that by the time they speak up to stop you, you are already done ... hehe.

 

[group_theory]

It's actually part of the resident's job to help you prepare to present to the attending. By now, they should realize that you need help (at least with this particular attending) so should at least be prepping you before you present (even do a mock presentation).

This is July - so the residents may not know that one of their supervisory role is to also help with the students.

Be proactive - ask the resident if he/she can spend 5-10 minutes with you in the morning to help organize your thoughts and prepare how to present. You can also ask the attending how you can improve on your presentation. Presenting is a skill that is learned with practice, and you are just starting out so you need practice and feedback. If your presentation is greatly improved at the end of rotation compare to the beginning, it will be noticed (unless it's a different attending at the end)

Also be aware that sometimes presentation can be different (even to the same attending) depending on what the attending's comfort level with the presenter (whether it is resident, intern, student). The resident's presentation might be a lot shorter and more concise (with a lot of pertinent negatives taken out of the oral presentation, and skipping nonrelevant PMH/SHx/FHx). The attending may expect the FULL H&P presentation from a student.

But the first thing is to ask your resident for help. Then ask your attending for feedback.


*I've also encouraged students to know their patients to a point that they can present the majority of the H&P without looking at a piece of paper - stuff like meds, lab values, vitals, etc they can look.

 

[heathermed]

I finally bit the bullet and asked the attending what I can do to improve my presentation. She handed me a New england journal of medicine. What the hell!!! I have 1 hr to see my patient before rounds at 730 am. how in the world can I go into all that detail by then?

Ok, i think at this point, its more me than anything. So what am i missing? i'm not dumb (seriously). Is there a fast way to do things that I simply don't know about? My interns are useless. I ask them to help me with something and they tell me to get back to them once they're done. But that never comes!

i'm so frustrated at this point. These couple of weeks are really putting a bad taste in my mouth... and to think i was soo excited to start rotations!

 

[scootad.]

I'm so glad I don't have to deal with bull**** like this anymore

 

[group_theory]

I finally bit the bullet and asked the attending what I can do to improve my presentation. She handed me a New england journal of medicine. What the hell!!! I have 1 hr to see my patient before rounds at 730 am. how in the world can I go into all that detail by then?

Ok, i think at this point, its more me than anything. So what am i missing? i'm not dumb (seriously). Is there a fast way to do things that I simply don't know about? My interns are useless. I ask them to help me with something and they tell me to get back to them once they're done. But that never comes!

i'm so frustrated at this point. These couple of weeks are really putting a bad taste in my mouth... and to think i was soo excited to start rotations!

Please realize that your interns are also busy. They are new to this too, and probably have lots of patients to see before 7:30AM. At this point, the interns are trying to stay afloat so I don't think it's fair to call them useless. That's why you should go to the senior resident and ask for help - hopefully without pre-rounding requirements, your senior resident can have a little extra time to help you (but also realize the senior resident(s) also have responsibilities in the morning).

It's unfortunate that your attending is less than helpful. If you happen to find another attending or resident that isn't on your team but receptive to helping you, ask if you can present your patients to them and ask for constructive criticism.

There is no fast way to do this - it's practice practice practice (along with incorporating the suggestions and feedback)

 

[TopSecret]

Hello...

I just began my IM rotation and my attending is really mean and doesnt try to teach me anything! I understand that they're really busy, but every time I present a patient and even before I finish 1 paragraph, she just goes like "you need to learn how to present before you come in front of me" and then tells me to stop and asks the intern to present the patient instead. This has happened 3 times in a row. I keep making changes in my presentation but I still keep getting the same response.

I start off with:

pt is a XXyo AAF/CF/etc with a history of XX who presented to the XX with (insert chief complaint here).

After this is where I think I screw up because whatever I say after this, I get cut off.

so can someone please help me on how to present a patient in IM. I tried reading alot of the notes that I school provides, but I'm still not getting anything.

thank you very much,
I would really appreciate it

If you're getting cut off, it's probably because the presentation is too long at least for that particular attending. Some are so pressed for time that they want a 10 sentence presentation with the diagnosis and plan accounting for the last 3-4 sentences.

Also, if you're presenting a patient that is a follow-up, you do not need to present the whole H&P again. Just present what happened overnight, the patient's current status, the most recent labs, and what the plan for the day is.

Another thing. It helps to state first the reason why the patient was brought to the hospital.

You could say: "Our next patient is Mr. ___ with a chief complaint of ____. He is a xx year-old man with a past medical history significant for___ who presented to the ER with ___...." This will help the attending focus on the pertinent positives and negatives from the get-go.

 

[The Angriest Bird]

I'm very sorry, and here's my advice.

What you just ran into is called a "f****** ******ed jerk from a specific place in hell". It happens and it is NOT your fault. In fact, I'm a 4th year now, and almost everyone I have talked to during my 3rd year has had someone like this.

1. DO NOT PISS HIM/HER OFF. Stay really low-key and just let the rotation end naturally. At this point, it's unlikely that you can do anything to help youself become better at presentation, and honestly I don't think you are the problem.

2. You need to think of ways to protect yourself. There is a small chance that this attending may actually FAIL you. I hate to scare you to death, but this kind of **** has happened to me. My course director had to intervene and convert the F to a C (he couldn't give me anything higher than that per policy). Be really nice to the residents in case one day you need them. Document anything that is highly inappropriate done to you by this attending and try to get witnesses. These are just for pre-cautions only. I know we are practicing a very defensive game here, but this is American medical education system. We have no choice.

3. DONT BE SURPRISED AT ALL THAT YOU WILL RECEIVE A BAD GRADE. I know it's much easier to say "and don't be pissed" than actually doing it. But you will soon find out that 3rd year is primarily driven by the "human factor". The least effort from a nice attending will get you a better grade than the most effort from a mean attending. It is life.

At last I have one good news: 3rd year is pretty much the only window period in your career during which you have to live thru this kind of ****. I've seen residents who piss off attendings on a daily basis, and they live long and prosper.

 

[The Angriest Bird]

So why don't you actually listen to how the intern presents and see what the attending wants? If it's happened 3 times at the exact same spot and you still don't get it, that pretty much just means you're a *******.

That is just very inappropriate, even on the Internet

 

[The Angriest Bird]

And definitely make sure you write a very detailed, objective, and constructive evaluation at the end of the rotation for this attending, if it's annoymous and won't affect your grade (they absolutely shouldn't in most if not all institutions).

We don't revenge, but attendings like this one don't deserve to teach. I must say that giving you a NE jounral of medicine part is completely bull****.

 

[Haemulon]

I feel for you. I have not had a malignant attending like this yet (but I'm only 5 weeks in). Although it has surprised me the extreme differences in expectations that different attendings and residents have about my presentations. Some want a nice long presentation with all relevant details (5 minutes or so in some cases) and others want to 10 second version.

I had a number of encounters that went something like this:

Att: "You have a patient for me?"
Me: "Yes Sir, Pt. Y is a XX y.o. G2P1 at X weeks GA by LMP presenting with ..."
Att interrupts: "Nevermind all that garbage, is the patient doing ok or not?"
Me: "She's fine, there are no apparent problems. ROS and PE were benign. FH was X and FHT's were Y. She's up to date with labs, all within normal limits". "
Att: "Good. I'll peak in and say hi, just have her follow up in x weeks."

Done. Ah well. My exhaustive H&P looks good on my notepad anyway. 😉