FIRST ALL RELAX!!! Have confidence in yourself!! You are going to be a doctor!! You were born to do this stuff! You excel in this area!! Pep talk yourself! Play your fav music, whatever, but you have got to feel confident going in and know that you have everything you need to succeed here. It doesn't matter about a previous time, exam, whatever.Shake that off and quit thinking about it. Thats in the past. Don't question it and don't allow it to make you feel inferior. Fluke crap happens. NOW go out there like your first time and rock this!
I can easily get nervous as well and did before this exam too...But once you get in there...after the first pt you will completely relax and realize how much you already know. You CAN EASILY get through all the important questions and a PE in less than 15min. Look, here is what I did:
START: ANNOUNCER-You may now begin
MOST IMP THING EVER: Take 30 seconds to 1 1/2 minutes. Jot down pts NAME - because you will address them by this several times in the encounter.
write their age, complaint and then to the top Right quickly think..of a few differentials that could be causing this complaint.
For example: IF CC was "Confusion" hypothetically, then I would write in no specific order: Meds, Overdoes/drugs, Hypoglycemia, electrolyte abn, depression/mental issue, Dementia (ALz, Multi infarct, etc), Delirium, head injury/fall, stroke, tumor, etc...just real quick to give myself some ideas to think about and factor in based on the pt's answers and history. As you get your History from the pt you may completely rule out some of these but they give a nice starting point...
Then I wrote vitals sometimes, and then the headings: PmedHx, Meds, PSurgHX, Social, Allergies, FamHx, Summary, and Conclusion on my scrap paper. --To remind me to ask about these things or do them. I swear not once did it take me over a minute and a half if that to write this stuff prior to entering the pt's room.
Then knock: "Hi Mr/Mrs .......Im so and so.....How are you doing today?"... Sit down or stand whatever you prefer..."How can I help you today (OR) what brings you here today?"....Pt talks for a minute maybe....."Ok can you tell me when this started?" OR "Can you tell me how long this has been going on?" ---ASK your Quick "Location, Onset, Duration, Radiation, Taken anything to alleviate it? Anything make it better/Worse? Any other symptoms associated with it ?" questions NOW. Can ask anything particularly relevant to their specific CC here too.
Then after getting that info I'd say (I usually ask my ROS here) "So I'm gonna go from top to bottom and see if anything else has been bothering you or has been related to this okay...Have you had any recent blurry vision, Changes in Hearing?...Dizziness, lightheaded feelings? Any HA, Fever or chills?, Any Sore throat? Coughing?, Any SOB? CP? Any belly pain? What about Constipation or diarrhea? Any blood in your stool or urine? " Pt would either say yes or no and sometimes that would trigger me to ask an additional question or such...
If they said No, Then I'd say "Okay good, What about any numbness or tingling anywhere in your body? Any weakness or feeling tired? Hows your diet? Have you been eating ok? Any weight changes you've noticed?."
THEN...I would look at my scrap paper and be reminded of my other important info to ask and I would say, "Okay I understand you're hurting, and I'm sorry but Let me ask you a few more quick questions about your past medical history if thats ok with you." ---Sometimes I would preface it with apologizing for something , other times I just said "Ok let me ask you a few more quick questions about your past med history"...
Then I asked the PMEDhx, MEds, Allergies, Social, Fam Hx, etc...All the answers will be quick..They are standardized patients and not there to talk to you for 7 minutes about their dad or mom's history.
At that point, I would summarize what they told me about their HPI and ask if they had any other questions/concerns or anything else I could help answer for them?
Then I would ask if it was "ok to examine them?"...Put the drape on them, washed my hands, and started the PE. I asked to remove gowns, and told them what I was doing the whole time. I ALWAYS did a heart and lung...sometimes that was all, sometimes I did a little more....NEVER more than 5min top and I dont even think any exam/ neuro or otherwise took that long. YOU CANT DO EVERYTHING...they know this. Ask a few things or do a few things from a long Neuro exam, etc and that will suffice.
AFTER PE: Then I would sit down on my stool again and summarize/Conclusion: I might say something like "Ok Mr/Mrs .....Based on what youve told me and my physical exam (I might tell them I did or didnt find anything on the PE), I think a few things could be going on/causing your symptoms. It might be due to...Blank....and so Id like to run a few tests such as..TEST A< B< etc...Or it may just be due to...BLANK....So If its okay with you Id like to run a few of these tests and see what they show and then Ill come back in here with you to discuss the results and we can figure out a plan together so that we can get you back on your feet and out enjoying your...blank....(whatever they told me) as soon as possible, okay?"
"Do you have any other questions for me or anything else I can help you
with?" No/Yes/whatever was said....
And Id stand up and say "Ok Mr/Mrs, Ill go put in these test and I'll be back shortly to talk with you okay?" Smiled and left the room....
OKAY you have seriously now been in the room with me! That was about verbatim what I did with every patient...give or take some talking/cracking a joke/preventive education/ or explaining a procedure or condition...
Tailor it to your words. Who you are as a doctor.
I was ALWAYS out before time. YOU CAN DO THIS!!! TRUST!! Relax, you are going to do well! Just be yourself, be friendly, and act like this is your grandmother or grandfather who is in the hospital coming to see a doctor...and they are scared, confused and alone...
Hope this helped.
GOOD LUCK!
