Hello Aspiring Physicians,
Hope everyone is doing well. It’s been a couple of months since my last post but happy to say that I am back doing what I love in the OR. I am even more excited as I get to have medical students back in clinic and in the OR rotating with me. I usually get the 3rd year medical students and some 4th year medical students if they are interested in Ortho. I love having medical students rotate with me for several reasons. I think it keeps me on my toes as the students always ask great questions that sometimes makes me think about why I do certain procedures for certain patients. And most importantly, I just love teaching.
At the end of the month, I am always asked to give an evaluation on how each student did on my rotation. This is always difficult for me because my evaluation may be the deciding factor between a pass and an honor during their 3rd year. But I do see something that ALL of my 3rd year medical students can work on throughout their training and I want to share that with you.
– How to Present a Patient-
Being able to present a patient is a core skill that every physician must master. Effective oral case presentations help facilitate information transfer among physicians and are essential to delivering quality patient care. Oral case presentation are a key component of how medical students and residents are assessed during their training. The hard part about oral presentations is that you must be able to adapt to different environments. Presentation of a patient in an outpatient setting (clinic) compared to in an inpatient setting (hospital) is very different. Oral presentations are even very different among specialties. Internal medicine patient presentations are very different than orthopedic patient presentations.
I wanted to give you an overview of how to present a patient. This will be for an internal medicine rotation then I will give you a quick comparison of an orthopedic patient presentation.
Oral case presentation can be made to an entire medical care team (up to 10 individuals) or maybe just to one person, such as an Attending. A couple of general guidelines:
Be confident, Don’t fidget, Use your note but don’t read verbatim from them, Be honest
Structure:
Opener: Brief one-liner that contains patient’s name, relevant past medical history and chief complaint
“Mrs. B is a 78 year old female with past medical history of chronic obstructive pulmonary disease (COPD) who presents to the hospital after she felt short of breath.”
History of Present Illness (HPI): “OPQRST” Onset, Paliative/Provoking, Quality, Region,, Severity of symptoms, Time
Review of Systems (ROS): General, Vision, Head and Neck, Pulmonary, Cardiovascular, Gastrointestinal, Genito-urinary, Hematology/Oncology, Ob/Gyn, Neurological, Endocrine, Musculoskeletal, Skin and Hair
*Only mention the positives
Past Medical History: Patient’s medical conditions, any past surgeries, reasons for past hospitalizations, current medications
Family History: Any relevant conditions that run in the patient’s family (focus on 1st degree relatives)
Social History: Living situation, occupation, Alcohol and tobacco abuse, recreational drugs
Physical Exam: Always begin with vitals: Temperature, heart rate, blood pressure, respiratory rate, oxygen saturations
Appearance, general impression, Head and neck, eye, respiratory, cardiac, abdominal, extremity, neurological
Results: Lab tests, Imaging, etc
*consider which results support your proposed diagnosis
Assessment and Plan: This is the most important part of your presentation and allows your team or Attending know how much you really now
Provide a brief summary
Differential Diagnosis: You should have 3-5 potential diagnoses. You should be able to explain who or why not each diagnoses matches the patient’s presentation
Plan: For medicine patients, this should include a list of the patient’s medical problems, ordered by acuity, followed by your proposed plan for each.
Let’s look at an orthopedic patient in clinic:
Mr. C is a 16 year old male who comes in with an acute right knee injury after he felt a pop while playing soccer. He states that it was a non-contact injury. He was unable to bear weight after his injury and his knee was very swollen. On exam, his vitals are within normal limits. He has a positive Lachman’s and McMurray’s with a 2+ effusion and full range of motion of his right knee. Plain radiographs are normal of the right knee. My differential diagnosis is ACL rupture, meniscus tear, and chondral injury. My plan would be to get an MRI of the right knee to confirm diagnosis.
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Remember that presenting a patient is a learned skill that you will be able to master with practice and attention to details. Know how to appropriately present a patient depending on your environment. And don’t be afraid to ask your Attending how they want a patient to be presented to them.
Hope this helps. As always keep grinding and Keep your head up.
Sincerely,
Your Med Mentor
