Presenting can be difficult, however, presenting well is a very good way to appear competent and impress doctors. Developing these skills are also essential for working as a junior doctor where you will often be expected to handover patients to seniors and colleagues. The key is to not simply regurgitate your history and examination but to pick out the most important positive and negative findings that inform and support your differential diagnosis. Be confident - it gets easier with practice so take every opportunity to present back to doctors on placement. Try and commit to a differential diagnosis and plan too!
GENERAL ADVICE |
Stay calm Don’t fidget: put your arms behind your back (some old-school consultants like you to take off your stethoscope and hold it behind your back). Don’t point at parts of your own body whilst presenting (remember in real life you may be presenting over the phone) Look at the examiner, not the patient Be clear, confident and definite about what you have found - “there was a murmur” not “umm, I think that there may have been a murmur” Work systematically - this makes it easier for you to remember everything and for the consultant to follow Don’t recount your entire clerking - only those bits relevant to the differential diagnosis Normal findings - only mention if being normal is unexpected in the context of other findings or is key in ruling out/in a possible differential Present back your findings after every examination you do - it gets easier the more you do it. You can also think about how you would present patients you have seen on the ward round or seen other doctors examine.
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BASIC STRUCTURE |
Introduce the patient | |
State presenting complaint | |
Detail the history | History of presenting complaint and associated symptoms, including risk factors and history relevant to the differential e.g. “The pain is made worse when coughing or straining, and radiates to the left flank” “The patient feels nauseous but there is no associated vomiting or weight loss noted” “The patient has a history of diverticulitis, the flares were managed conservatively”
Past medical and surgical history: “In addition to the diverticulitis, Mrs X has hypertension and type II diabetes” “There is no relevant surgical history of note”
Give a drug history including drug allergies (and what happens). If you know the doses then say them but if not, you can just list the medication. It is good practice to state why the patient takes the medication if known. “Mrs X takes 40mg atorvastatin at night for high cholesterol, a beta blocker for hypertension and metformin to control her diabetes” “Mrs X has an allergy to penicillin which results in an anaphylactic reaction”
Any relevant family and social history. Patient’s baseline function is usually worth mentioning, especially if surgery is being considered, but living conditions etc are generally not relevant for a differential diagnosis but should be recorded in the notes to inform discharge planning
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Examination findings | General impression: Most relevant finding(s): Some people prefer to not jump to the most relevant finding and instead report all findings systematically- either approach is ok as long as you remember to present everything relevant! Report other relevant findings systematically e.g. “Peripherally, koilonychia and conjunctival pallor were noted” “There were no other peripheral stigmata of disease” Remember crucial negatives: “There were no scars indicative of previous abdominal surgery or any hernias present”
What do the findings imply? State what still needs to be done:
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Concluding | |