Presenting on Rounds

[vegas]

My 2nd thread of the night.

I'll be starting clinicals in a few months and last week I had my first experience presenting a patient.....man was I sweating bullets!! I was so nervous my throat was dry my legs were numb, I thought I was going to pass out for sure! I did ok in the end but it was a horrific experience!! I think the intimidating part of it is the hierarchy and not to mention the attending does not even look at you when your presenting which makes it all the worst because I felt like I was being ignored. Not really sure if I'm looking forward to clinincal right now??? Can anyone share their experiences and/or advice for combating this "inferiority complex" on wards.

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[imtiaz]

we all know how you feel. weve all been there. the only way to get past this is to just keep doing it over and over and over again. it gets a lot easier the more you do it. there will always be those attendings that are just dicks to med students, but they have a reputation and you kinda know what to expect going into it with them, but otherwise most attendings are nice and will give you pointers. dont worry about it, just keep up the good work!

 

[bts4202]

During my IM rottaion, one of the senior residents sat me down and taught me how the present. It helped a lot, here was some of his advice.

try to start off by trying to present everything important about why the pt is here in ONE sentence. Use this format

Mr/Mrs X is a [age] year old F/M with a past medical history of [include pertinent history only] presented with [insert presenting symptoms and important labs saying only pertinent positives and negatives], our working diagnosis has been [insert working diagnosis] and we started [insert Rx's].

I know this is a terrible run on sentence, but go with it anyways.

Following that, the attending should know everything he/she needs to know to continue. Follow that up with overnight events, how the pt is improving or decompensating, additional findings, etc. The rest of the presentation should flow pretty naturally from then on.

 

[Benzo4every1]

Yep, on my fourth rotation, my senior resident sat me down and talked me through a presentation. he was super nice about it. I still get stage frights presenting to an attending, because the attending wants it in 8 sentences or less and Im staring at my H&P spilling away. I still suck at it, but Im more confident in presenting now then say, when I was on my first rotation.
It just gets better with practice and some attendings intimidate you more than others.

 

[vegas]

Is it ok to look at your sheet and read it all off when presenting? I've noticed there are some who can spit it all out w/o paper in hand...I mean how is it possible to remember all of those major details like lab values etc.. w/o missing a thing? A photographic memory would be nice!

 

[GonnaBeAnMD]

Is it ok to look at your sheet and read it all off when presenting? I've noticed there are some who can spit it all out w/o paper in hand...I mean how is it possible to remember all of those major details like lab values etc.. w/o missing a thing? A photographic memory would be nice!

I am very interested in this question as well.... whether we can read all this stuff or not?

 

[bts4202]

It is acceptable to have a sheet of paper in front of you and to refer to it as needed, but it is unacceptable to just read from a sheet of paper. Believe me, when you really get involved in the pts diagnosis and management, those details stick in your mind because they all factor into your decision making process.

 

[Samir Desai]

Some attending physicians don't mind if students read off of their paper while others can't stand it. Best thing to do is to ask the attending what he or she prefers. Early on, when you haven't presented much, I think it's better to use your notes. I say this because the whole experience can be daunting with notes let alone without notes, especially when you are new to it. After you have some presentations under your belt and your confidence level has picked up, it's a good idea to work on presenting without relying so much on notes. The key is practice, practice, practice. Every medical student has the ability to do this but it does require a lot of work. It's worth the effort because even if your attending says it's okay to read your notes, I can tell you he or she will be very impressed if you present with a puacity of notes (that is, if you do it well). By the way, you don't have to memorize everything. For example, if a patient has a number of abnormal lab test results, most people would find it reasonable if the presenter used notes to convey the results.

Best of luck with presenting,

Samir Desai, MD

 

[GonnaBeAnMD]

Some attending physicians don't mind if students read off of their paper while others can't stand it. Best thing to do is to ask the attending what he or she prefers. Early on, when you haven't presented much, I think it's better to use your notes. I say this because the whole experience can be daunting with notes let alone without notes, especially when you are new to it. After you have some presentations under your belt and your confidence level has picked up, it's a good idea to work on presenting without relying so much on notes. The key is practice, practice, practice. Every medical student has the ability to do this but it does require a lot of work. It's worth the effort because even if your attending says it's okay to read your notes, I can tell you he or she will be very impressed if you present with a puacity of notes (that is, if you do it well). By the way, you don't have to memorize everything. For example, if a patient has a number of abnormal lab test results, most people would find it reasonable if the presenter used notes to convey the results.

Best of luck with presenting,

Samir Desai, MD

My issue with presenting without reading is that I stutter if I'm not reading... not fun. By the way, how many people will we typically be presenting to? I will have to just take a hit on the grade and read because stuttering gives off the wrong impression that I'm nervous and don't know what I'm talking about to some people. In reality, it happens a lot of times even if I'm not nervous. Add being nervous and stressed to it, and it's

 

[sacrament]

What sucks is that every attending wants the presentation done in a different way, and some of them have rather eccentric requirements. I just spent the first five weeks of my medicine rotation honing my presentations to meet a particular attending's demands, and by the end he was routinely telling me what excellent presentations I was giving. My head swelled; I was surely the most gifted presenter to walk these halls. Enter the next medicine attending, who, after my first presentation to her, essentially asked me what the hell my problem was, and why was I presenting in such a ass-backwards and generally ******ed manner? Was I dumb or did I just not care? The very specific and idiosyncratic desires of the five zillion attendings you'll work with during third year is one of the most frustrating aspects of the whole godforsaken experience.

 

[vegas]

What sucks is that every attending wants the presentation done in a different way, and some of them have rather eccentric requirements. I just spent the first five weeks of my medicine rotation honing my presentations to meet a particular attending's demands, and by the end he was routinely telling me what excellent presentations I was giving. My head swelled; I was surely the most gifted presenter to walk these halls. Enter the next medicine attending, who, after my first presentation to her, essentially asked me what the hell my problem was, and why was I presenting in such a ass-backwards and generally ******ed manner? Was I dumb or did I just not care? The very specific and idiosyncratic desires of the five zillion attendings you'll work with during third year is one of the most frustrating aspects of the whole godforsaken experience.


What was your method of presenting patients to your first attending?

 

[starayamoskva]

What sucks is that every attending wants the presentation done in a different way, and some of them have rather eccentric requirements. I just spent the first five weeks of my medicine rotation honing my presentations to meet a particular attending's demands, and by the end he was routinely telling me what excellent presentations I was giving.....


What was your method of presenting patients to your first attending?

New Patient Presentation

(Patient's name) is a (age) yo (race)(gender) with a past medical history of (list significant diagnoses) admitted on (date) at which time he presented with symptoms of (list symptoms and characterize with location, quality, severity, timing-onset/duration/frequency, setting, aggravating/alleviating factors; list pertinent negatives). Report pertinent PMH (report status of medical conditions such as signs of end-organ damage in DM and HTN, BP control on medications, last HgbAIc/home glucoses, last TSH, last FEV 1, last creatinine, last echo results, etc.), PSH, all medications including OTC, allergies, social history/family history (if pertinent). (Pertinent positive/negatives from ROS should be reported in HPI.) Physical exam on admission was significant for (list vitals, pertinent physical findings including pertinent negatives). Lab / EKG / CXR / diagnostic tests on admission were significant for (list pertinent lab abnormalities, EKG/CXR findings, compare EKG to past EKG). He/she was admitted with a diagnosis of (list diagnoses) with (physically diagnostic findings). Treatment included (list medications begun- IV/PO,IVF,02). Report patient's status since admission.


Daily Patient Presentation

(Patient's name) is a (age) yo (race)(gender) with (current diagnosis requiring hospitalization) currently being treated with (medications- IV/PO, IVF, 02, antibiotic/anticoagulation day number). Report any overnight changes in condition (or any changes over past 24 hours if on attending rounds). Report patient complaints today, vitals/physical exam findings (improvement, worsening or stable findings), pertinent lab/diagnostic test results, and plan.

 

[DrMom]

The very specific and idiosyncratic desires of the five zillion attendings you'll work with during third year is one of the most frustrating aspects of the whole godforsaken experience.

Apparently the entire purpose of MS3 is to turn your world upside down as soon as you have your bearings.

 

[Samir Desai]

My issue with presenting without reading is that I stutter if I'm not reading... not fun. By the way, how many people will we typically be presenting to? I will have to just take a hit on the grade and read because stuttering gives off the wrong impression that I'm nervous and don't know what I'm talking about to some people. In reality, it happens a lot of times even if I'm not nervous. Add being nervous and stressed to it, and it's

I agree with you that people may mistakenly assume that you are nervous if you stutter. Consider discuss your stuttering with your attending physician and resident early in the rotation. Give them a chance to understand why it happens rather than letting them mistakenly assume that you are stuttering solely because you are nervous or lacking confidence.

Samir Desai, MD

 

[GonnaBeAnMD]

Thank you for your input Dr. Desai! How many people will we be presenting to? Attending only? + Med students? Thanks again

 

[tupac_don]

Is it ok to look at your sheet and read it all off when presenting? I've noticed there are some who can spit it all out w/o paper in hand...I mean how is it possible to remember all of those major details like lab values etc.. w/o missing a thing? A photographic memory would be nice!

Its actually not that tough, when you are presenting day in and day out. You will know it and it will stick in your head. Especially if you practice to do it iwthout paper, you will get even better at it.

 

[tupac_don]

What sucks is that every attending wants the presentation done in a different way, and some of them have rather eccentric requirements. I just spent the first five weeks of my medicine rotation honing my presentations to meet a particular attending's demands, and by the end he was routinely telling me what excellent presentations I was giving. My head swelled; I was surely the most gifted presenter to walk these halls. Enter the next medicine attending, who, after my first presentation to her, essentially asked me what the hell my problem was, and why was I presenting in such a ass-backwards and generally ******ed manner? Was I dumb or did I just not care? The very specific and idiosyncratic desires of the five zillion attendings you'll work with during third year is one of the most frustrating aspects of the whole godforsaken experience.

If you don't mind me asking, how did you present to that first doctor?

 

[praying4MD]

One of my medicine attendings gave me this advice:

1) Start when called upon and speak fast: it gives listeners less chance to ask questions you don't know answers to.

2) Don't hesitate to lie. Just don't lie if you hesitate. If you know the potassium was normal, but don't remember the actual number and are asked while presenting, say it with confidence: "It was 4.1." Confidence, confidence, confidence.

3) And when all else fails, if you're gonna cry, cry hard and cry early. Just make sure you're a chick.

Thought that was entertaining.

 

[dynx]

If you can see that the attending is opening his mouth to ask a question during a part of your presentation you're not that familiar with (exact lab value for example) immediatly up the volume and speed of your presentation and hit something else important...the stronger you roll through it the less chance they have to ask questions. This is why it's best to memorize rather than read, you can look at the attending and see if they are going to ask questions...as the poster above said, if they are opening thier mouth to ask a qustion when you're giving lab results then say - K normal around 4.1 (speed through the normal) they'll focus on the number not the around...if you wait for them to ask the number then tell them it was 4.1 when it was 4.2, thats a lie and some dick that knows the value is bound to chime in.

 

[bts4202]

Better advice than lying is to actually know the important lab values! if your pt is on lasix, it is not too hard to figure out that you need to know the pts' electrolytes. If the pt has diverticulitis, then it is not too hard to figure out that you need to know the pt's CBC. If the pt is on vanc, know the most recent random or trough vanc level. If they ask you something you did not expect, that is ok... they expect you to miss things. But your answer should be "I do not know, but I will find out".... NEVER EVER LIE. If you get busted lying, you will be chewed out harder than you can imagine and, in fact, I have seen someone kicked out of a rotation for lying like that too many times.

 

[praying4MD]

Better advice than lying is to actually know the important lab values! if your pt is on lasix, it is not too hard to figure out that you need to know the pts' electrolytes. If the pt has diverticulitis, then it is not too hard to figure out that you need to know the pt's CBC. If the pt is on vanc, know the most recent random or trough vanc level. If they ask you something you did not expect, that is ok... they expect you to miss things. But your answer should be "I do not know, but I will find out".... NEVER EVER LIE. If you get busted lying, you will be chewed out harder than you can imagine and, in fact, I have seen someone kicked out of a rotation for lying like that too many times.

It was a joke. And I was quoting my attending.

 

[bts4202]

It was a joke. And I was quoting my attending.

Ahhh, lol. OK.

 

[JAMMAN]

The first time I ever presented a patient, I just read my five page H&P. The next time I presented a patient my attending told me I only had three minutes. So I read my five page H&P really fast!

True story....

 

[AF_PedsBoy]

The first time I ever presented a patient, I just read my five page H&P. The next time I presented a patient my attending told me I only had three minutes. So I read my five page H&P really fast!

True story....

LOL that's hilarious!

I agree with the changing presentations style - it's even worse right now because I have four different attendngs at the same time because I have Medicine, Pulmonary, GI, and Renal patients, and they all want different specific information in their presentations, without the excess crap the other attendings want lol. Touching base with them during the day is pretty heinous too because instead of running through 6 patients in one shot I have to page each one individually =P

 

[ericdamiansean]

The first time I ever presented a patient, I just read my five page H&P. The next time I presented a patient my attending told me I only had three minutes. So I read my five page H&P really fast!

True story....

You just need practice, lots of it.
My wards are really warm, and I was sweating buckets, when I presented, there I was going through my notes and my attending told me 'Relax, it's just a presentation' and went on to wipe my forehead with a piece of tissue..man, you get them any nicer than this anymore

 

[organicmatter]

my favorite is when the attending/residents pressure the students to present their patient quickly and efficiently and then they subsequently waste time joking about annoying patients and incompetent nurses, etc.