Hi, I know that I will be required to speak to my team in the PBAR format for presentations, and do it in front of the family + team while on rounds for my subinternship. Can anyone supply me with a sample patient presentation done in the PBAR format which will also be appealing and understandable to non-MD patient families?
thanks for your help!
So, honestly, and all joking aside, "bedside rounds" are pretty important from a few viewpoints standpoint. One, it tests how well the student has connected with the patient (or in this case, the family). If you start saying how things went over night, and the patient/family has this HUH!? look on their face, evaluator says "you don't have patient ownership, you just make **** up." Two, its pretty stressful, way more than table rounds, and so it evaluates the student's ability to perform under pressure. Which means you will spend more time formulating a plan, researching your patient and your patient's condition, and even spend more time WITH the patient.
For the family, at least for me, it isn't about bringing the family into the conversation. Its about demonstrating how much mental entergy goes into forming decisions. The patients see us for about 5 minutes in the morning, then 5 minutes with the massive mass of white coat we call "the team." They don't see how much discussion goes into their case, nor how much time and care. Even if they ARENT part of the conversation, they are presnet, and they see the power of the mass-white-coat. This often makes the patient's satisfaction increase, and even increases compliance.
IF the attending wants the family, I, well, I'm not that useful.
IF the attending wants the family there for the reasons I've decsribed above, then I can help. The whole point of PBAR (I use SOAP) it to write down the important things of the day. This is a written communication to talk to other teams who may come see the patient. All of that information (like every drug they are on, all the normal physical findings) are
important but they aren't
relevant. It becomes curcial for you to then find the relevant information, to "tell a story the attending wants to hear" that is concise, points out pertinent positives and negatives, and summarizes with the plan. Short, sweet, and often VERY difficult to do.
Relevant doesn't mean short. Concise doesn't mean "talk really fast." It means get out the important information that helps decision making. And it should be a story the ATTENDING wants to hear, not the family.
Hope that helps!
Dont say the things in [brackets]
"[
S]
This is Patient Johnny Bottom, here with ALL status post chemo with a neutropenic fever. Last night there were no acute events and Johnny slept through the night without complications. Specifically, no fevers or chills. [O] His vitals overnight were Tmax 36-1, Heart Rate 112-126, Blood Pressure 100-110/75-86, with an SpO2 of 99% on room air. Physical exam had no relevant positives. His labs from today show a worsening neutropenia, with an ANC dropping from 450 yesterday to 400 today; white count about the same (1.3 to 1.1). All other blood lines are stable. Chem 7 is normal. Blood cultures drawn on tuesday are negative times 3 days. [A/P] So, in summary, this is a 7 year old child with ALL status post chemo with neutropenic fever. One, neutropenic fever. He is on his fourth day of cefepime for the fevers, and he will start filgastrim today to start boosting his white cells. Two, ALL, is status post chemo. Three, discharge pending a nomral ANC and afebrile x 48 hours. He has been afebrile for 24 hours.
Totally made tha tup. But if you read it, it takes about two minutes. Slowly.
Of course things change if you've got a dude who is all about thoroughness (which I think is bogus, but thats opinion).
