In my most recent post, I discussed the first 2 rules of presenting on a consult service. In this post, we’ll take the next step. Actually, this rule could go for any type of presentation, even in the clinic.
Rule Number 3: When discussing a patient who has a chronic disorder, it is important to “frame” the patient’s pertinent medical history in the first few sentences.
This rule is specific to a situation in which the chronic disorder is strongly related to (or actually the reason for) the consultation, and is an extension of Rule Number Two.
Here is the framework I suggest:
- How/when the patient presented
- How the patient was diagnosed
- How the patient was treated
- How the patient responded to treatment
- What complications the patient has experienced
“Dr. Jones asked us to see Mr. Smith because of diarrhea and a history of Crohn disease. Mr. Smith is a 24-year old man with a history of Crohn disease, diagnosed 4 years ago after he presented with 6 weeks of right lower quadrant abdominal pain, diarrhea, and weight loss. He underwent a colonoscopy, at which point numerous ileocecal ulcerations were found. He was initially treated with Pentasa, but did not improve. He was then treated with prednisone, and his symptoms improved, but he developed hyperglycemia and Cushingoid features. He was unable to wean off steroids, so he was placed on 6-MP, but was switched to infliximab because of marked elevation of his transaminases. Last year, he underwent ileocecal resection because of obstructive symptoms and the development of a distal ileal stricture. Since then, his symptoms have been under very good control, until 3 weeks ago, when his diarrhea returned…”
Notice how the points are covered in a logical progression, and a complete medical story can be conveyed in just a few sentences.
These tips have been invaluable in helping me formulate oral presentations for the consult/liason psychiatry service I’m currently rotating through. Thanks so much! 🙂
You’re welcome, glad you found them helpful! Thanks for the comment.
When teaching communication skills we also emphasise the patients views of what has happened. What did he think the cause was? What is he worried about? Are there any particular concerns about treatment options?
Agreed, we talk about this as well. I compartmentalize that in terms of patient evaluation, and I’m sure it’ll be the subject of a future blog.
I’m a surgeon. Residents who haven’t been taught otherwise always give confusing presentations for inpatient surgery consults, giving a CC/HPI of belly pain without mentioning the patient has been inpatient treating pneumonia for a week. Or, they start with CC/HPI of SOB and get around to the reason for the consultation five minutes into the phone call.
I give them this framework: Reason for consult. Admitting/current diagnosis. Date of admission. Then, begin a presentation, with CC/HPI focused on the reason for the consult.
I enjoy your blog.
Thanks Chris. Framework is very important RDM
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