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beyond all hope

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This is a question for senior residents and academic attendings. What is your style for taking presentations?

Do you just listen, then see the patient, then write your H&P? This is probably the best way but I find it cumbersome when you're constantly being interrupted and you have boatload of blank charts at the end of your shift. (assuming you can even FIND the charts you haven't written on. I hate paper charts)

Do you write the H&P based on the presentation, and then just see the patient and hope you agree with the resident? This is a lot more streamlined as far as organization, but if you totally disagree with what the resident told you you're forced to cross things out which looks really bad on a chart.

I've been doing a hybrid approach where I mostly take the hx verbatim, see the patients with chart in hand, and chart the pertinent physical findings (I find it's in the PE that I disagree with my residents the most)

Thoughts?
 

southerndoc

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I'm very quick in the ED. Usually I see the patient immediately when they arrive and go ahead and start the workup. As seniors, we see about 3-4 patients/hour during peak times. It helps with flow to see them and start the workup.

By the time interns or second-year residents present, I've usually already written my note.

I don't think this hinders learning for the residents, and it dramatically increases flow in the ED as patients are usually there for 30-90 minutes before a junior resident is able to see them.
 
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