There was one attending I worked with in residency who had a kind of different way of writing histories.
For those of you who are used to presenting patients, the usual way you would present a patient who comes in to be assessed for ulnar neuropathy and also has diabetes would probably be something like this:
Patient is a 58 year old man with a history of diabetes who presents with one year of worsening numbness in the last three digits of his right hand. He also has pain in his right elbow and... etc etc
But my attending hated this. He said he liked us to get right to the problem in the first sentence. So he kept changing my histories to something like this:
Patient is a 58 year old man with a one year history of worsening numbness in the last three digits of his right hand. He also has pain in his right elbow and..... etc etc.... pain wakes him at night. He also has a history of diabetes.
The diabetic history is pretty important in any nerve exam so it definitely needs to be in the history, but to me that seems a little sloppy. But what do I know?
I learned early on to adjust them to who you're giving to. They should be the same no matter what, but adjusting to what they expect totally cut out the anxiety of giving to the particular people.
ReplyDeleteI agree with the first line just telling you the presenting problem. It is mind numbing to listen ot trainee's presentations, when each sentence is loaded with 4,5,6 facts. It produces hypnotic effect on attendings. Then when they wake up they start asking you about the history, and you just told them all of it, they were not listening.
ReplyDeleteIf a nurse reports to doctor we do SBAR: Situation, background, assessment, recommendation.
ReplyDeleteEven being a nurse I am finding that giving a good report as an NP to a MD is a challenge that needs to be learned from good preceptors.
ReplyDeleteI am sure you noticed, but congrats on being picked up by Kevin M.D. That was a great post. I am surely glad that my job does not require writing histories.
ReplyDeleteHaha... you mean the article that has 100+ comments, about a quarter of which are mine? ;)
DeleteThis guy is sort of attacking me on there, saying I sound miserable with my job and I need to learn to handle stress better, like the full time physician moms that he knows at his job.
I think that's the one. Part time. I remember mostly good comments, and didn't see that one. Well, he is exposing himself there - you always come out smelling like a rose, ha ha.
DeleteIt's some guy who calls himself JD (like in Scrubs?). He punctuated our argument by saying, "Thanks for giving all women who work part time a bad name." I considered saying, "Thanks for giving all male doctors a bad name," or some equally ridiculous broad generalization.
DeleteI hated getting interrupted by the attending during a patient presentation. You lose the flow, you get flustered, and that makes you seem more incompetent. As an attending now, I try hard not to do this and save all my questions and feedback until after they're done.
ReplyDeleteWhile I prefer my presentations the usual way, I try not to push a resident to change their flow. If I do that, they are more likely to accidentally leave something important out of their presentation.
ReplyDeleteI was taught that if this was the patient's first consult, the chief complaint is reported first, then history then the relevant comorbids. If this was a follow up, or a confined patient, the relevant comorbids are reported first then the chief complaint then the history. But what do I know, I'm just a med student
ReplyDelete