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Old 05-02-2013
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Question is it imp to summarize the encounter

hi i wanted to know if its imp to summarize the encounter,like towards your closure or somewhere in between or can we go without it?
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Old 05-03-2013
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It is extremely important, it will count towards both your ICE and CIS, by doing this you are showing the patient you actually addressed his concerns and payed attention to him (CIS part) and by doing it correctly you are showing good data gathering (ICE part)

If you have to cut short in something that has to be the PE
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Old 05-05-2013
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Do you mean we need to say something like "Mr.___, you came today with complaints of ___..You told me that you have ___ symptoms for which I performed a PE" Then move to the closure and advice? That sounds like it could take alot of time.

Isn't it enough to say "After speaking with you and doing your PE,I feel you might have ___ and I'd like to run a few tests to comfirm your diagnosis"..Then advice the pt?

Isn't the latter one short,sweet and to the point?
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Old 05-05-2013
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Quote:
Originally Posted by megz2107 View Post
Do you mean we need to say something like "Mr.___, you came today with complaints of ___..You told me that you have ___ symptoms for which I performed a PE" Then move to the closure and advice? That sounds like it could take alot of time.

Isn't it enough to say "After speaking with you and doing your PE,I feel you might have ___ and I'd like to run a few tests to comfirm your diagnosis"..Then advice the pt?

Isn't the latter one short,sweet and to the point?
I think he means something like: "Mr. ____, just to make sure i haven't missed anything so far, you've told me that you've had ____, for this longs, bla bla bla, is there anything else you would like to add??" ...basically summarize all the info you collected from the history.

Hope it helps!
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Old 05-05-2013
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Originally Posted by HelpmeUSMLE View Post
I think he means something like: "Mr. ____, just to make sure i haven't missed anything so far, you've told me that you've had ____, for this longs, bla bla bla, is there anything else you would like to add??" ...basically summarize all the info you collected from the history.

Hope it helps!
I get what you're saying. But that's gonna take a lot of time,right? I mean imagine saying "Mr. ____, just to make sure i haven't missed anything so far, you've told me that you've had pain in your abdomen for 1 year, which was sudden in onset, 6/10 in severity associated with heartburn and is aggravated on eating. You also drink 6 glasses a week and smoke 2 PPD...etc etc etc..is there anything else you would like to add" + COUNSEL,TESTS and DIAGNOSIS.

Won't that take over a minute or 2 to cover that? Is it a good idea? I'm a little worried about running out of time for the counseling, which is the most imp part in CS.
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Old 05-06-2013
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Originally Posted by megz2107 View Post
I get what you're saying. But that's gonna take a lot of time,right? I mean imagine saying "Mr. ____, just to make sure i haven't missed anything so far, you've told me that you've had pain in your abdomen for 1 year, which was sudden in onset, 6/10 in severity associated with heartburn and is aggravated on eating. You also drink 6 glasses a week and smoke 2 PPD...etc etc etc..is there anything else you would like to add" + COUNSEL,TESTS and DIAGNOSIS.

Won't that take over a minute or 2 to cover that? Is it a good idea? I'm a little worried about running out of time for the counseling, which is the most imp part in CS.

SO what if it takes a minute? in fact you should take at least 2 to 3 minutes to summarize and counsel the patient, do not underestimate this, 6-7 minutes should be spend questioning the patient, 2-3 TOP in PE and the rest in summarizing, counseling and closure.

Practice makes perfection
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I did it to every pt and i always had at least 1 minute to spare! you just have to practice and practice! Plus, if you have no problems with the english, it shouldn't take that long! Make sure to be calm and assertive! :P (like the dog whisperer) GL
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I did it to every pt and i always had at least 1 minute to spare! you just have to practice and practice! Plus, if you have no problems with the english, it shouldn't take that long! GL
Exactly
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Old 05-06-2013
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Originally Posted by XpaezX View Post
SO what if it takes a minute? in fact you should take at least 2 to 3 minutes to summarize and counsel the patient, do not underestimate this, 6-7 minutes should be spend questioning the patient, 2-3 TOP in PE and the rest in summarizing, counseling and closure.

Practice makes perfection
Thanks alot! I think I'll need to speed up the PE bit.

I had another question..Lets say I got a neuro case (which requires an extensive PE) and the Pulm, Heart and Abd PE is irrelevant. Is it ok to focus on PE for Neuro only and don't do any other systems(Neuro alone will take 2-3 mins)? Coz all of FA cases have Chest, Heart and Abd PE?

Thanks guys! y'all are helping me alot!
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Originally Posted by megz2107 View Post
Thanks alot! I think I'll need to speed up the PE bit.

I had another question..Lets say I got a neuro case (which requires an extensive PE) and the Pulm, Heart and Abd PE is irrelevant. Is it ok to focus on PE for Neuro only and don't do any other systems(Neuro alone will take 2-3 mins)? Coz all of FA cases have Chest, Heart and Abd PE?

Thanks guys! y'all are helping me alot!
I would suggest that you start by doing the neuro exam, and if you still have some time try to do heart and chest (takes only 20-30 seconds or so), just for completions sake...It also depends on the age of the patient....if its a 25-30 yo, you could skip it....but if its a 65-70 yo, it would be wise to check and write it down on PN, even if its not relevant to the case. Abdominal you can skip regardless.

Thats my opinion. hope it helps!
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Quote:
Originally Posted by megz2107 View Post
Thanks alot! I think I'll need to speed up the PE bit.

I had another question..Lets say I got a neuro case (which requires an extensive PE) and the Pulm, Heart and Abd PE is irrelevant. Is it ok to focus on PE for Neuro only and don't do any other systems(Neuro alone will take 2-3 mins)? Coz all of FA cases have Chest, Heart and Abd PE?

Thanks guys! y'all are helping me alot!
u always do the relevant exam first no matter what FA says... if u hv time ausculate heart and lungs and as mentioned earlier try to listen to cartoid in elderly esp if they hs past h/o of htn, dm, or hypercholestremia...
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Old 05-06-2013
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Quote:
Originally Posted by megz2107 View Post
Thanks alot! I think I'll need to speed up the PE bit.

I had another question..Lets say I got a neuro case (which requires an extensive PE) and the Pulm, Heart and Abd PE is irrelevant. Is it ok to focus on PE for Neuro only and don't do any other systems(Neuro alone will take 2-3 mins)? Coz all of FA cases have Chest, Heart and Abd PE?

Thanks guys! y'all are helping me alot!

You do Neuro first and if you have time at least ausculate the heart and / or the chest... Never do both.

If the patient is old and after questioning you found HTN/history of angina but the chief complain is neuro then you would start with cardiac and THEN neuro (cardiac etiology can be the cause of the neurological complains; I.E cardiac arrhythmia).

Depends on the case but the goal of CS is to do a FOCUSED questioning and clinical exam.

FA is wrong on so many levels.... Most cases are impossible to do exactly as FA says, so stick to the basics and focus on relevant info only.
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............ the chief complain is neuro then you would start with cardiac and THEN neuro (cardiac etiology can be the cause of the neurological complains; I.E cardiac arrhythmia).
I understand your point (cardiac etiology can be the cause of the neurological complains) but I will ALWAYS do the Neuro exam first in a case with the CC of Neuro and then Cardio (time permitting) since I will have some cardiac symptom on History (funny sensation/palpitaion etc) anyway and the cardio exam is most likely to be normal anyway since it is very difficlt to simulate an arrythmia as compared to weakness or loss of sensation/DTR.
Just my 2cents
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I understand your point (cardiac etiology can be the cause of the neurological complains) but I will ALWAYS do the Neuro exam first in a case with the CC of Neuro and then Cardio (time permitting) since I will have some cardiac symptom on History (funny sensation/palpitaion etc) anyway and the cardio exam is most likely to be normal anyway since it is very difficlt to simulate an arrythmia as compared to weakness or loss of sensation/DTR.
Just my 2cents
Yes... that is true, however a cardiac exam will take you 20-30 seconds, whereas neuro exam can take all of the PE...

It is better to have cardiac exam + 75-80% of the full neuro exam than 100% of the neuro exam alone... I mention this for the sake of PT and data gathering completeness...

Just my 2 cents but it depends on what you like and on the individual performance.
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