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Old 03-01-2014
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Default Summarizing

Hi guys,
I have been practising to summarize the history and counsel during the closure, but I found it makes the closure lengthy for me and I get scared of running out of time,then start talking faster . I was thinking about summarizing the history and do the counselling before PE. Is that okay? Or is it necessary to summarize once during the closure?

Thanks in advance..
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Old 03-04-2014
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can anyone help?
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Old 03-04-2014
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Quote:
Originally Posted by drglo View Post
Hi guys,
I have been practising to summarize the history and counsel during the closure, but I found it makes the closure lengthy for me and I get scared of running out of time,then start talking faster . I was thinking about summarizing the history and do the counselling before PE. Is that okay? Or is it necessary to summarize once during the closure?

Thanks in advance..
Its ok to summarize before the PE, but you need to do the PE to have a better picture of what it is..So, its easier to tell the patient what you think it is and speak better on it.
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Old 03-04-2014
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Originally Posted by rockstar88 View Post
Its ok to summarize before the PE, but you need to do the PE to have a better picture of what it is..So, its easier to tell the patient what you think it is and speak better on it.
Thanks for replying

Well, I am going to summerize the history only anyway, because there are rarely any PE findings. Even if there is I am not going to explain them to the patient. So, basically I am going to summerize the Hx (if possible counsel also) before the PE, then do the PE and get a clear picture, then in closure I am going to give my impression about the Dx and workup + answer any challenging question. How does that sound?

If I keep all these for the end, I feel like I am running out of time, then start speaking faster, and also miss 1/2 things. If this is ok, I am going with this plan..
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Old 03-05-2014
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Quote:
Originally Posted by drglo View Post
Thanks for replying

Well, I am going to summerize the history only anyway, because there are rarely any PE findings. Even if there is I am not going to explain them to the patient. So, basically I am going to summerize the Hx (if possible counsel also) before the PE, then do the PE and get a clear picture, then in closure I am going to give my impression about the Dx and workup + answer any challenging question. How does that sound?

If I keep all these for the end, I feel like I am running out of time, then start speaking faster, and also miss 1/2 things. If this is ok, I am going with this plan..
I need to pay attention while typing..I meant, you can summarize before the PE, but you need to do PE for a proper closure..Bcz you may find more things on the PE and you will have more differentials to talk about.
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Old 03-07-2014
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Default Summary of History and PE

I recommend putting the summary after the PE and before your differential diagnosis. It makes sense here and helps the lead-in to the differential diagnosis. Only add information in the summary of the history that will affect your diagnosis - if the SP says they don't smoke or always use a condom or they have no weight change, forget it! Don't mention it unless it's important. And because you are generally dealing with healthy people, often the PE is simply "And the physical exam looks normal." is enough. If the SP displays pain during the PE, of course mention that. So it could be "You have pain in the lower part of your abdomen and it was more uncomfortable when I pressed it but everything else looks fine." BTW, abdomen is OK -it is not a medical word. Feel free to use belly if you like, too. Naturally right lower quadrant, suprapubic and epigastrium are medical terms and the SP will react to them either by asking you "What's that?" or hit you in the evaluation. However you can say "You have pain in the epigastric area, this area here." (pointing to the affected area - patient education is always OK).
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Old 03-08-2014
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I would recommend summarizing before you start the PE. You can utilize the time you need to wash hands/wear gloves to do this. SPs give you a LOT of important and useless information during the HPI and you'll be understandably nervous during those tachycardia inducing 8 minutes or so. So summarizing mid way will prevent you from making mistakes and also help recap all the pertinent positives in the HPI. Also remember to ask some ice breaking question like "boy! the winters were harsh this time!" or "watched any movies lately?"....

Closure is WAY more important than summary, so i would recommend you keep atleast 2-3 minutes for that and the challenging question. Just my 2 cents. Good luck!
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