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Flashcards in CM Deck (20):
1

Why do oral presentations?

Patient care

  • To organize and summarize your patient’s story for yourself and your team.

Consultation

  • To seek expert opinion about your patient’s problem

Teaching

  • To permit discussion and learning from your patient

Assessment

  • To demonstrate to your teachers how well you understand your patient’s case

2

Listener's attention

3

Opening Statement

Patient’s age should always be included

The chief concern should always be included.

  • If patient presents multiple CC’s pick at most three to open
  • Not the diagnosis, the chief concern!!

Significant medical history or risk factors pertinent for the patients presenting concern should be included

  • Exclude minor diagnoses that are not relevant
  • Should not be an exhaustive list

Symptom duration is important
 

4

HPI

The HPI is your patient’s story

Should be one of the longest parts of the history

Details should create a rich picture of the patient’s illness

Transition into the illness

A good HPI starts with the patient in their usual state of health and follows them into the illness

Chronological

Note times as relative to day of admission

Just the facts, ma’am

Avoid editorializing or making interpretations

Like most good movies, the HPI is

Detailed, creating a rich tableau of the patient’s illness

Onset

Location

Duration, and timing, is it getting better or worse

Character

Aggravating/Alleviating factors

Radiation

Treatment

Significance

As much as possible, include the patient’s perspective

Your HPI is a story, but also an argument for your leading diagnosis/es

After the story,

Choose information from the past, family, and social history, and the review of systems that helps you weigh the diagnostic possibilities

The story and the pertinent positives should come before the negatives.

5

antecedent care

If your patient has sought medical care for this problem already– in the ED or at an outside location— discuss the details of the symptoms BEFORE you discuss the other providers’ diagnosis and treatment

Your listener needs to decide what she thinks is going on before you tell her the presumed diagnosis and plan of care.

6

additional medical history

PMH/PSH/Past OB gyne/Past Psych

Meds/Allergies

Family History

Social History

Review of Systems

Your oral presentation should include only what is so important that your listener must hear it

Present in the standard order

Simply leave out sections without relevant information or state “noncontributory”

Avoid repetition

Say, “Family history is as noted in the HPI,” if you went over it already and there is no additional information

7

past medical history

Choose illnesses and episodes of care that are important and/or relevant

  • Major, serious illnesses, like cancer, heart disease or diabetes are nearly always important
  • Minor diagnoses like a prior radial fracture may be important if considering symptoms of bone disease or arm pain, but usually will not be relevant and belong only in the write-up

Often you will expand upon an illness you touched on in the HPI

  • Avoid total repetition

8

medications

Ask your listener if they want a full list or just pertinent medications

Most listeners will not want doses

Exclude topical medications if not relevant

9

allergies

Present all serious, true allergies (anaphylaxis, severe rash, etc.)

Leave out mere intolerances unless they affect this episode of care

10

family history

Often non-contributory

It’s not necessary to prove you took a detailed FH

11

social history

Include living situation, occupation, tobacco/alcohol/drug use

Only include other details when relevant and not already mentioned

  • Sexual history very relevant for someone with a genital lesion
  • Diet history very relevant for a patient with uncontrolled diabetes

12

Review of Systems

This section should almost always be left out of the oral presentation

  • Positive ROS and pertinent negative ROS should have been stated in HPI

If you discover an important new problem during your review of systems interview, you should create a second paragraph within your HPI.

13

physical examination

The physical examination must be presented in order from head to toe.

  • General and vital signs come 1st and are always included
  • Be specific about vital signs

Pertinent organ systems should be included even if findings are unremarkable

Abnormal findings should usually be described unless they are very minor, e.g. a benign skin lesion

Describe what you observe. Do not interpret findings in the PE

  • 2/6 holosystolic murmur at the apex” NOT mitral regurgitation murmur 

14

labs and studies

Present relevant labs and studies (xrays, CT, EKG etc)

Summarize them

  • May present only the BUN and creatinine and not the sodium in some cases

Compare them to previous values

Don’t interpret them

15

assessment and plan

Requires medical knowledge and clinical reasoning

A summary statement

Problem by problem

  • A differential diagnosis, when relevant
  • An argument for and against items on the differential
  • A plan

16

summary statement

One or two sentences

Patient’s age

Important risk factors such as medical history

Important information from the history, physical and labs

  • not just a repeat of your opening statement

Your leading diagnoses

17

assessment

Several sentences reasoning through each of your diagnostic possibilities, marshalling evidence from the case

Best to have three or more diagnoses in mind: one may well be right!

No surprises!  All case information should have been contained in the presentation already

You can assess several problems

18

plan

Often divided into diagnostic and therapeutic plans

Will become better as you learn more therapeutics over the third and fourth year

19

style of speech

Speech: Convey confidence and engagement

  • Be clear, enunciate
  • Speak loudly enough to be heard, but don’t shout
  • Speak slowly and calmly
  • Vary your cadence, don’t speak in a monotone
  • Avoid vocal tics such as “um, like, so”

20

body language