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Purpose of the oral presentation
Learning a skill that you will use for your entire career -- and that skill is to be able to communicate in a way that enables you to present the patient to any other health-care provider in a concise manner. It is like learning another language.
New patients get the traditional H&P with assessment and plan. Give the chief complaint and a brief and pertinent HPI. Next give important PMH, PSH, etc. The ROS is often left out, as anything important was in the HPI. The PE is reviewed. Only give pertinent positives and negatives. The assessment and plan should include what you think is wrong and, briefly, why. Then, state what you plan to do for the patient, including labs. Be sure to know why things are being done: you will be asked.
The follow-up presentation differs from the presentation of a new patient. It is an abridged presentation, perhaps referencing major patient issues that have been previously presented, but focusing on new information about these issues and/or what has changed. Give the patient’s name, age, date of admission, briefly review the present illness, physical examination and admitting diagnosis. Then report any new finding, laboratory tests, diagnostic procedures and changes in medications.
The attending physician will ask the patient’s permission to have the medical student present their case. After making the proper introductions the attending will let the patient know they may offer input or ask questions at any point. When presenting at bedside the student should try to involve the patient.
There are four things you must consider before you do your oral presentation
The opening statement should give an overview of the patient, age, sex, reason for visit and the duration of the complaint. Give marital status, race, or occupation if relevant. If your patient has a history of a major medical problem that bears strongly on the understanding of the present illness, include it. For ongoing care, give a one sentence recap of the history.
This will be very similar to your written HPI. Present the most important problem first. If there is more than one problem, treat each separately. Present the information chronologically. Cover one system before going onto the next. Characterize the chief complaint – quality, severity, location, duration, progression, and include pertinent negatives. Items from the ROS that are unrelated to the present problem may be mentioned in passing unless you are doing a very formal presentation. When you do your first patient presentation you may be expected to go into detail. For ongoing care, present any new complaints.
Most of the ROS is incorporated at the end of the HPI. Items that are unrelated to the present problem may be briefly mentioned. For ongoing care, present only if new complaints.
Discuss other past medical history that bears directly on the current medical problem. For ongoing care, have the information available to respond to questions.
Provide names of procedures, approximate dates, indications, any relevant findings or complications, and pathology reports, if applicable. For ongoing care, have the information available to respond to questions.
Present all current medications along with dosage, route and frequency. For the follow-up presentation just give any changes in medication. For ongoing care, note any changes.
Note frequency and duration. For ongoing care, have the information available to respond to questions.
Home, environment, work status and sexual history. For ongoing care, have the information available to respond to questions.
Include all significant abnormal findings and any normal findings that contribute to the diagnosis. Give a brief, general description of the patient including physical appearance. Then describe vital signs touching on each major system. Try to find out in advance how thorough you need to be for your presentation. There are times when you will be expected to give more detail on each physical finding, labs and other test results. For ongoing care, mention only further positive findings and relevant negative findings.
Give a summary of the important aspects
of the history, physical exam and formulate the differential diagnosis. Make
sure to read up on the patient’s case by doing a search of the literature.
Billings JA, Stoeckle JD. The Clinical Encounter: A Guide to the Medical Interview and Case Presentation. Chicago: Year Book Medical Publishers, 1989. [Cooper Library: WB290 B598c 1989]
Billings JA, Stoeckle JD. The Clinical Encounter: A Guide to the Medical Interview and Case Presentation. 2nd ed. St. Louis: Mosby, 1999.
Lingard L, Haber RJ. Teaching and learning communications in medicine: a rhetorical approach. Academic Medicine. 74(5):507-510 1999 May.
Lingard L, Haber RJ. What do we mean by "relevance"? A clinical and rhetorical definition with implications for teaching and learning the case-presentation format. Academic Medicine. 74(10):S124-S127.
Yurchak PM. A guide to medical case presentations. Resident Staff Physician. 27:109-115 (1981)
A Guide to Medical Case Presentations. In Survival Manual: A Guide to the Clinical Years (AMSA, 1985)
The Oral Presentation (A Practical
Guide to Clinical Medicine, UCSD School of Medicine)