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  #1  
Old 01-12-2013
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Clock Time Managment of the CS Encounter

I seem to be able to accomplish an encounter and counsel the pt within 15 minutes, but I am seriously just right on 15 minutes...

Have no extra time left except for simple cases.

How do you guys increase your speed and efficacy?
I do not want to be super fast with pt - do not want to look like anxious idiot with a stethoscope!
But being casual and emphasizing is very time consuming
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Old 01-13-2013
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I also notice that I'm struggling with the time. But so far, these are the measures I've taken to alleviate the problem:

For the counselling, I try to shorten the "script". There are many suggestions in the internet/books. I just choose the simple ones.

I also notice in csevideos that the Dr speaks very fast. She doesn't seem to hurry the patient. It's just that she talks fast and that she asks questions without pausing to think. Pretty amazing actually.

I guess that's why we need to practice a lot. To be able to almost memorize the questions for each case.

Good luck!!
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Old 01-14-2013
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Just do it more & more, until you get comfortable with the time issues, at the end it is not big deal. The magic word is practice.
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Old 01-14-2013
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Alright, here is a thing,
If you stick to FA and go with all their suggestions, apply your Hx taking mnemonics, summarize and then do their suggested PE - you will be out of time already, but you need to close and counsel yet.

Key thing - forget about FA PE suggested exam - that is way too long, you've got no time to waste, especially for folks who's english is poor.

I think the answer is to do a very focused PE and never bother about anything else.

With 15 minutes youve got very little time to think, so it goes down to memorization and applying several algorythms to a pt and just being flexible with interchanging them
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Old 01-14-2013
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Quote:
Originally Posted by ag2011n View Post
Just do it more & more, until you get comfortable with the time issues, at the end it is not big deal. The magic word is practice.
Practice is a term for a real life setting, where you are not as short with time.
Here it comes down to memorization and an ability to produce favorable expression of a polite and professional physician.
But I hear you.

Btw, has anyone ever calculated how many mistakes does FA have?
Just sayin...
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Old 01-14-2013
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You do not need to ask all the questions in FA book for each case, they just help you to frame the case. In real exam, you will feel the time even shorter, that because of the stress. With practice you get faster & more confident.
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Old 01-18-2013
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after a week of practicing I came up to a conclusion that only 75% of each case questions in FA should/need to be asked. All the rest is a junk that slows you down.
You just need to trim that junk out.
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Old 01-18-2013
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Originally Posted by DocSikorski View Post
after a week of practicing I came up to a conclusion that only 75% of each case questions in FA should/need to be asked. All the rest is a junk that slows you down.
You just need to trim that junk out.
I think you are correct.
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Old 01-21-2013
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Hey, can someone tell me (who took CS recently)
Do we only see pt's info at the door (Name, age, cc and VS) or we also get it when we sit at the computer?
VS is my main concern - takes too much time to put down by the entrance.
Thanks
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Old 01-21-2013
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Quote:
Originally Posted by DocSikorski View Post
Hey, can someone tell me (who took CS recently)
Do we only see pt's info at the door (Name, age, cc and VS) or we also get it when we sit at the computer?
VS is my main concern - takes too much time to put down by the entrance.
Thanks

I also have the same query, what I would do is just write the VS that is abnormal and the rest put them as "WNL" .
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Old 01-21-2013
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Quote:
Originally Posted by DocSikorski View Post
Hey, can someone tell me (who took CS recently)
Do we only see pt's info at the door (Name, age, cc and VS) or we also get it when we sit at the computer?
VS is my main concern - takes too much time to put down by the entrance.
Thanks
No,you will see VS and other info on the door only, nothing beside computer, but you can get up and look up again, if forgot

Last edited by marina99; 01-21-2013 at 03:31 PM. Reason: forgot
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Old 01-22-2013
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Quote:
Originally Posted by DocSikorski View Post
Hey, can someone tell me (who took CS recently)
Do we only see pt's info at the door (Name, age, cc and VS) or we also get it when we sit at the computer?
VS is my main concern - takes too much time to put down by the entrance.
Thanks
There are two tabs on the PN window. The other tab gives the doorway information if you need it. Don't need to get up and look at the door.
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  #13  
Old 01-22-2013
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Originally Posted by drssbaz View Post
There are two tabs on the PN window. The other tab gives the doorway information if you need it. Don't need to get up and look at the door.
Thanks,I ve heard that if you press on examinee detail tab,the page might get hanged,is it true? my cs is on 24..:sorry:
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Old 01-22-2013
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There are two tabs on the PN window. The other tab gives the doorway information if you need it. Don't need to get up and look at the door.
Like on the official website?
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Old 01-22-2013
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Quote:
Originally Posted by marina99 View Post
No,you will see VS and other info on the door only, nothing beside computer, but you can get up and look up again, if forgot

1)hey if a patient comes in with right arm pain and asks you to give a note that he needs a leave . how do you know that the patient is malingering or is it in real becoz both will say they are in deep pain and will not allow you to examine the joint saying its painful ?? so what do you reply ??? will you give him a leave note ???

2) and in the same case if the patient says its very painful to touch the arm , do you say ok i will not exam it becoz we are not suppose to do painful maneuvers ??? or say that i need to do the exam to know the reason of your pain , i dont know if the patient will check this as negatively or positively ?

what do you guys suggest ?
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Old 01-22-2013
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Yes like the official website.
I did it on my own exam, the page didn't hang up on me.

Best of luck to all of u.
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Old 01-22-2013
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Default yes and no

Quote:
Originally Posted by Hitman View Post
1)hey if a patient comes in with right arm pain and asks you to give a note that he needs a leave . how do you know that the patient is malingering or is it in real becoz both will say they are in deep pain and will not allow you to examine the joint saying its painful ?? so what do you reply ??? will you give him a leave note ???

2) and in the same case if the patient says its very painful to touch the arm , do you say ok i will not exam it becoz we are not suppose to do painful maneuvers ??? or say that i need to do the exam to know the reason of your pain , i dont know if the patient will check this as negatively or positively ?

what do you guys suggest ?
I dont think you want to touch painful spot again and again, so once its enough, unless you want to see rebound( abdo, not arm
According to CSE videos, Dr.Reynolds was giving sick leave notes, so I believe its permitted to promise such a note
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Originally Posted by marina99 View Post
I dont think you want to touch painful spot again and again, so once its enough, unless you want to see rebound( abdo, not arm
According to CSE videos, Dr.Reynolds was giving sick leave notes, so I believe its permitted to promise such a note

No i was saying as soon as you touch it the pt will claim its painful : so what to do you do here , tell him that you need to examine to know the cause or let it go saying i wont touch it ??? ; secondly how would you know that the patient is malingering ??? and third if i dont know if he is malingering then should i give him a leave note ??? or say i will wait for the test results ?
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Old 01-22-2013
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Default painful

Quote:
Originally Posted by Hitman View Post
No i was saying as soon as you touch it the pt will claim its painful : so what to do you do here , tell him that you need to examine to know the cause or let it go saying i wont touch it ??? ; secondly how would you know that the patient is malingering ??? and third if i dont know if he is malingering then should i give him a leave note ??? or say i will wait for the test results ?
Pt told me on my abdo cases that it hurts in epigastric area, i didnt touch it again, because I already have supportive for my ddx such an abdo tenderness , why do I have to touch painful area again?Unless I need to show rebound as a supportive for appendicitis etc. Do not complicate things!
Malingering is dx of exclusion, it should not be on the top of your ddx list, even if you suspect malingering, but you dont have results of the tests, how you can prove its malingering? so, Id give a note foe 1 or 2 days, till have results of lab work
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Old 02-08-2013
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Quote:
Originally Posted by Hitman View Post
No i was saying as soon as you touch it the pt will claim its painful : so what to do you do here , tell him that you need to examine to know the cause or let it go saying i wont touch it ??? ; secondly how would you know that the patient is malingering ??? and third if i dont know if he is malingering then should i give him a leave note ??? or say i will wait for the test results ?
I think your question has been answered.
However, technically each one of the SPs is malingering because they are paid for it.
Just don't piss off your patient. It's his/her insurance that pays you.


Best of Luck!
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