I know there are many topics about this, but I would like some advice and tips please. As for the CIS portion, I have made somewhat of a template for me to use. I know cases may vary and I am prepared to deal with them as they go, but for the most part plan to run it like this. What do you guys think?
I will start with my intro: "Good morning Ms/Mr. so and so, Im Dr. blah blah, Its very nice to meet you (smile if the situation calls for it, dont smile if they are in distress). Being that this is our first encounter, I do want you to know, I take the overall health and well being of my patients very seriously, any issues you have big or small, please feel free to bring them up"
"I would also like to know if you are currently comfortable?" Wait for response, "at any point during the session, you need anything please feel free to ask" (they say ok)
"Is it ok if I have a seat here?" Yes
"Mr/Ms. Is it ok if I take notes while we talk?" Yes
"Mr/Ms. If its ok with you I would like to begin.... What can I help you with today"
They start with there story, then say "I'm sorry to hear that, you made the right choice by coming in so we can figure out how to help you" (Smile).
Ofcourse during sexual and social hx, inform them that the questions may be about their private life, but it is important in evaluating their overall health and reassure that everything is confidential and nothing leaves the room.
Somewhere at the end of the HPI, ask what part of their life is being affected the most.
Right before physical exam, "If you can put ur finger on it, what do you think may be the issue or assosciated with it" Let them responsd.
"I understand, Do you have any questions or concerns for me"?
"If you dont mind Ms/Mr. Blah Blah, I would like to start my physical exam"
Go wash hands "So mr./ms. blah blah, it must be fun working as a....... it must be fun to have 2 kids running around........... did you do anything fun this weekend?.........." These questions help to connect with the patient more.
Conduct exam, ofcourse always ask before doing a manauver, let them know what you are doing. If any time they are in too much pain blah blah blah, help them.
Finally closing part. " Mr./Ms. blah blah, I recommend you stop smoking, this can be detrimental to ur overall health, are you interested....... Whenver you are are ready, I'll be more than happy to assist you, or if they drink, tell them to calm down on the drinking and that we have guidance counselors that can help, or if abused, let them know social worker can help them with getting a shelter and being safe. Console on drugs, dieting, or anything else that requires you too.
Close with Mr./Ms. Blah blah, you told me this and that, right? Based on your PE, I think this may be the problem............. I will have to do this test and this test. Do you agree with my plan? Do you have any questions or concerns for me?
"Thank you very much Mr./Ms. Blah blah We are going to work through this and figure out whats going on and tackle it on together. I will call you as soon as I get the results". It was very nice meeting you (smile)
Of course if they have some problem like back pain, I would advise them to rest and take NSAIDs for now if it is a lumbar strain.
Any advise or tips would be helpful. I am well aware that there will always be situations, where this approach has to be modified.
I barely failed the CIS portion, last time. I basically ran through this routine, however I never asked them What they might think the problem was, I didn't add any small talk while washing my hands, I also didn't ask what part of their life was affected the most, because why the f*** would you ask someone who has a kidney stone that question, but thats how NBME wants it........ Also did not close on 2 cases. Actually did well on the ICE portion.
I will start with my intro: "Good morning Ms/Mr. so and so, Im Dr. blah blah, Its very nice to meet you (smile if the situation calls for it, dont smile if they are in distress). Being that this is our first encounter, I do want you to know, I take the overall health and well being of my patients very seriously, any issues you have big or small, please feel free to bring them up"
"I would also like to know if you are currently comfortable?" Wait for response, "at any point during the session, you need anything please feel free to ask" (they say ok)
"Is it ok if I have a seat here?" Yes
"Mr/Ms. Is it ok if I take notes while we talk?" Yes
"Mr/Ms. If its ok with you I would like to begin.... What can I help you with today"
They start with there story, then say "I'm sorry to hear that, you made the right choice by coming in so we can figure out how to help you" (Smile).
Ofcourse during sexual and social hx, inform them that the questions may be about their private life, but it is important in evaluating their overall health and reassure that everything is confidential and nothing leaves the room.
Somewhere at the end of the HPI, ask what part of their life is being affected the most.
Right before physical exam, "If you can put ur finger on it, what do you think may be the issue or assosciated with it" Let them responsd.
"I understand, Do you have any questions or concerns for me"?
"If you dont mind Ms/Mr. Blah Blah, I would like to start my physical exam"
Go wash hands "So mr./ms. blah blah, it must be fun working as a....... it must be fun to have 2 kids running around........... did you do anything fun this weekend?.........." These questions help to connect with the patient more.
Conduct exam, ofcourse always ask before doing a manauver, let them know what you are doing. If any time they are in too much pain blah blah blah, help them.
Finally closing part. " Mr./Ms. blah blah, I recommend you stop smoking, this can be detrimental to ur overall health, are you interested....... Whenver you are are ready, I'll be more than happy to assist you, or if they drink, tell them to calm down on the drinking and that we have guidance counselors that can help, or if abused, let them know social worker can help them with getting a shelter and being safe. Console on drugs, dieting, or anything else that requires you too.
Close with Mr./Ms. Blah blah, you told me this and that, right? Based on your PE, I think this may be the problem............. I will have to do this test and this test. Do you agree with my plan? Do you have any questions or concerns for me?
"Thank you very much Mr./Ms. Blah blah We are going to work through this and figure out whats going on and tackle it on together. I will call you as soon as I get the results". It was very nice meeting you (smile)
Of course if they have some problem like back pain, I would advise them to rest and take NSAIDs for now if it is a lumbar strain.
Any advise or tips would be helpful. I am well aware that there will always be situations, where this approach has to be modified.
I barely failed the CIS portion, last time. I basically ran through this routine, however I never asked them What they might think the problem was, I didn't add any small talk while washing my hands, I also didn't ask what part of their life was affected the most, because why the f*** would you ask someone who has a kidney stone that question, but thats how NBME wants it........ Also did not close on 2 cases. Actually did well on the ICE portion.
