The group of medicine interns were presenting patients and I had spent a lot of time really getting to know my patients case and the details of everything. When it came my turn the attending turned to me and said I am running short of time, give me a quick one-liner. I started to briefly state the patients current situation and the attending interrupted and said One line!. I thought he meant to state the current situation in one line so I started again. He quickly interrupted me and said Is there anyone else who knows something about the patient? One of the other residents hesitantly did a detailed introduction of the patient and her illness though he missed some info since I had helped with the admission and knew more about the patient. Now I know what our attending meant by one-liner but how embarrassing - and I am also thinking there goes my evaluation.
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Messed up on rounds
Started by lsres
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relax - this happens often. every attending has their own preferences about how much detail they want during patient presentations. is it fair that they don't guide you in what they want? yep, but there's nothing you can do. just try and figure out what they want and do your best to give it to them. one episode shouldn't determine your entire evaluation.
move on with your life.. you cant get into his head and read his mind.. if it makes you feel better tell him to meet you outside and you can settle the score like that
it sounds like you're a new 3rd year, if so, you shouldn't worry about not giving a good 1 liner. it's actually a skill unto itself (that you should learn), but that people aren't inherently born with. i'm not the best at it, but i try to include: Age and sex, RELEVANT PMH (including if pt has been recently admitted for same problem), presenting complaint, any MAJOR lab/imaging findings.
IE: 74 yo man w/ HO CHF sp miX2 who's been in hospital 3 times this year w/ chf exacerbation presented to ED last night with dyspnea and was found on cxr to have pulmonary edema.
IE: 74 yo man w/ HO CHF sp miX2 who's been in hospital 3 times this year w/ chf exacerbation presented to ED last night with dyspnea and was found on cxr to have pulmonary edema.
Actually, I think lsres is a resident or an intern.
Why are you embarrassed? If he just said "give me a quick one-liner," he wasn't being specific enough. If he had said "give me the patient's background in just one line," that would have been clearer. It's not your fault that he wasn't able to clearly communicate what he wanted.
Yes. Thanks for your comments. I will try to relax and keep moving forward. I am participating as an observer right now in order to get more experience with the program and a good letter of recommendation. I did not match this year despite passing Step 3 as well as having good letters of recommendation, and am hoping that the observership experience will help.
Usually male attendings want numbers. "91 y/o Afib EF of 20% INR 5, Hb 7, 3x3 cm retroperitoneal bleed". That one sentence tells you all you need to know.
Try to quantify everything and then present just the number.
Cancer - present the stage (and if possible TNM) "Stage III NSCLC".
CHF - state the EF% and PA pressure. "Class IV EF20% PA pressure of 60".
Neuro - never say "hx of stroke". That is worthless..quantify the type and severity. "L MCA infarct GCS 12".
ID - Say # cxs positive and how much. "2/4 bottles >100k Ecoli."
- Never present an HIV patient without listing a last known CD4. "HIV CD4 70"
- Never say an abx w/o saying day #. "Vanc/Zosyn Day #4".
Renal - if possible say the CrCl, not the Crt. "Clearance of 22".
GI - if liver failure, include the MELD score. "HepB MELD of 25".
- Any postsurgery or post-procedure, say post-op day. "POD#3 exlap".
Quantify, quantify.
Try to quantify everything and then present just the number.
Cancer - present the stage (and if possible TNM) "Stage III NSCLC".
CHF - state the EF% and PA pressure. "Class IV EF20% PA pressure of 60".
Neuro - never say "hx of stroke". That is worthless..quantify the type and severity. "L MCA infarct GCS 12".
ID - Say # cxs positive and how much. "2/4 bottles >100k Ecoli."
- Never present an HIV patient without listing a last known CD4. "HIV CD4 70"
- Never say an abx w/o saying day #. "Vanc/Zosyn Day #4".
Renal - if possible say the CrCl, not the Crt. "Clearance of 22".
GI - if liver failure, include the MELD score. "HepB MELD of 25".
- Any postsurgery or post-procedure, say post-op day. "POD#3 exlap".
Quantify, quantify.
Don't be embarrassed or intimidated by your attending's roughness. This kind of treatment happens to the best of us as well as the worst of us. Just forget about it and move on.
If you're doing an observership and you learned medicine in a place where the typical American oral presentation is not practiced or taught, and you're looking for letters of recommendation....
PRACTICE! Practice both "one line" oral presentations and more thorough ones. Practice one-liners, three-liners, and full presentations. Ask your fellow interns and residents to help you with a few and give you feedback. Don't let your pride get in the way of asking for help.
The oral presentation is part of the medical culture and if you don't know how to make a simple oral patient presentation, then you have a communication problem. Persistent communication problems do not go over well in the workplace and will not help you get hired, so practice the presentation however and whenever you can.
If you're doing an observership and you learned medicine in a place where the typical American oral presentation is not practiced or taught, and you're looking for letters of recommendation....
PRACTICE! Practice both "one line" oral presentations and more thorough ones. Practice one-liners, three-liners, and full presentations. Ask your fellow interns and residents to help you with a few and give you feedback. Don't let your pride get in the way of asking for help.
The oral presentation is part of the medical culture and if you don't know how to make a simple oral patient presentation, then you have a communication problem. Persistent communication problems do not go over well in the workplace and will not help you get hired, so practice the presentation however and whenever you can.
Alot of this depends on the mood of the attending. Some days they want it all, others they want nothing. You have to play it by ear and not take it too personally, although, being a medical student/intern/resident trying to make your best impression, it can be really nerve-racking. Some days you'll guess what they want correctly, other days they will kill you with their stare and yells. Just keep on truckin' and work hard.
I feel the OP's pain. One of the very worst things on IM was when you spent the morning getting ready to do a great presentation and then the attending shows up late and wants to do "quick rounds" with the chief.
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Don't practice. And don't overthink it. Presenting will come naturally if you just relax and don't worry about trying to impress your attending who is not a god or a superman. And then, one day, you will be done jumping through hoops like a trained poodle and you will have conversations with physicians, not dissertations.
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Usually male attendings want numbers. "91 y/o Afib EF of 20% INR 5, Hb 7, 3x3 cm retroperitoneal bleed". That one sentence tells you all you need to know.
Try to quantify everything and then present just the number.
Quantify, quantify.
thanks!
Usually male attendings want numbers. "91 y/o Afib EF of 20% INR 5, Hb 7, 3x3 cm retroperitoneal bleed". That one sentence tells you all you need to know.
Try to quantify everything and then present just the number.
Quantify, quantify.
thanks!
yes and female attendings want "emotional one liners"...lol. "the patient is a lovely 99 year old female with beautiful wavy salt and pepper colored hair..."
I agree, but make sure you keep presenting as much as possible. If you duck out on presentations, you will never get better.
also, a good medicine resident who has the time will try to go over presentations with the medical students, so that you're prepared for formal rounds with the attending. so, maybe you should just ask your resident if he/she has the time to go over your patient.
