what do u say to facilitate the review of systems?

[bulldog]

i have a tendency to spend way too much time on the ROS--sometimes more than the physical exam itself as I start interviewing patients. What can/do you say to make it faster? thanks.

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[EVMSPeds]

I go head to toe, yes or no questions...for example, "headache? dizziness? lightheadness? vision? chest pain? SOB? belly pain?" and so on...it should only take two or three minutes...unless of course you get a patient like mine yesterday who actually said "Yes, I've actually been having blood in my stool for the last year...sometimes it fills the bowl." Great....thanks.

 

[AF_PedsBoy]

"Oh, and before we do your physical exam, I just want to do a quick review to make sure you don't have any other problems we haven't caught... DOES ANYTHING HURT??? No? Ok...is ANYTHING WRONG??? No? ARE YOU SURE??? Ok lemmie just wash my hands and we'll get on to the physical..." 😀

 

[ericdamiansean]

Systemic review is unremarkable.............

 

[njbmd]

Hi there,
I do the ROS while I am doing the physical exam. It gives me something to discuss with the patient while I am examining things. When I am doing otoscope exam, I review ear problems. With the opthalmoscope, I review eye problems etc. The whole process goes faster and the patient does not feel like an object. This was a trick that my Family Practice preceptor taught me and it has served me well through three years of residency.
nbjmd 🙂

 

[scootad.]

What I sometimes do is ask "do you have any problems with urinating, changes in stool" to make the ROS go faster instead of asking specifically about hematuria, hesitancy, dysuria individually. Dont know if this is the right thing to do, but whatever its faster that way. 😉

 

[cytoskelement]

Hi there,
I do the ROS while I am doing the physical exam. It gives me something to discuss with the patient while I am examining things. When I am doing otoscope exam, I review ear problems. With the opthalmoscope, I review eye problems etc. The whole process goes faster and the patient does not feel like an object. This was a trick that my Family Practice preceptor taught me and it has served me well through three years of residency.
nbjmd 🙂

I second that notion.

Also, I've found it easier to remember more of the pertinent questions when I'm examing a particular area. Although, I've found that I often have to remind the patient to refrain from talking while I'm ascultating.

 

[uclaman25]

Hi there,
I do the ROS while I am doing the physical exam. It gives me something to discuss with the patient while I am examining things. When I am doing otoscope exam, I review ear problems. With the opthalmoscope, I review eye problems etc. The whole process goes faster and the patient does not feel like an object. This was a trick that my Family Practice preceptor taught me and it has served me well through three years of residency.
nbjmd 🙂

Yup, I also find that to be the best way of doing ROS. Allows you to talk to the patient while you're doing your PE. I found my patients getting bored if I'm just sitting there asking them, "weight change? change in appetite? sore throat, runny nose, cough, fever, headache, sneezing, diarrhea, vomiting, constipation, blah blah blah blah blah"

 

[Blade28]

I also do the ROS during the physical.

 

[AF_PedsBoy]

Asking questions during the physical IS the easiest and most efficient way of doing the ROS - however it's also the one thing that will absolutely get you failed at our school because they say you're "not organized enough" and the "history and physical should be separate." Yet another win for the separation between what medical school is, and what the real world is.

(although sometimes it's useful because you need to know a little bit about everything as a student versus specializing, and you're still learning, but STILL! Come on, get off the ******ed anal rules if it's not helping!)