hellohellonj
Forum Junior
Topics: 17
Posts: 24
|
hello, How should we explain the PE results? eg, a SP have a rebound tenderness, positive Murphy sign, psoas sign?
Another Q is: how to explain to SP that he needs invetsigation of colonscopy, LP for CSF study, TEE (transesophageal echocardiogram)?
Thanks in advance!!!
|
| drmamu
Forum Elite
Topics: 43
Posts: 188
|
hai guys, The basic idea is to explain everythimg in layman language. You can tell that your belly examination suggests that there is an inflammaytion in your appendix, take small amount of tissue from the liver for testing, you want to scan the heart through a tube passed through the food pipe and such things. Whatever you want to say , think for sometime and present it in a common mans language. If you use a medical term, explain it before thae patient asks. Itt is always safer to speak about test using general term. Tell blood sugar test that assesses blood sugar for 3 months rather than telling hba1c
|
| hellohellonj
Forum Junior
Topics: 17
Posts: 24
|
drmamu,
Thank you for response. Do I really need to tell the patient that I am going to scan his/her heart using a tube via the food pipe, scan his/her gut by inserting a tube through the gut? Or simply say I will do some image study of her heart / gut? 
|
| drmamu
Forum Elite
Topics: 43
Posts: 188
|
AS i said, It is always safe to tell about simple test like scanning the heart, liver, etc. If you are very particular about speaking about trans-esophageal echo, you may express that in the way I said. But it is always safer to talk and explain about simple tests. I will be happy to answer any other doubts you have.
|
| hellohellonj
Forum Junior
Topics: 17
Posts: 24
|
drmama,
Thank u 4 help!
Another Q is the Pt note. The Step 2 orientation material gave 2 sampes of PN. http://www.usmle.org/step2/Step2CS/Step2CS2006GI/...
I like the example 2 better due to its simplity. However, UW and first aid only gave the eample in 1st comprehensive format. So I doubt which one is more popularly used in the real exam.
BTW, 's/ SOB' means 'with SOB", right? Want to make sure?
THANKSSS!!!
Attached Files:
Doc1.txt (0 KB, 4 downloads)
|
| drmamu
Forum Elite
Topics: 43
Posts: 188
|
Patient note should brief and specific. You can follow any way you like provided that you are fast and do not need to spend time for thinking. I had severe shortage of time. Just keep on writing whatever comes into your mind in an orderly fashion. There wont be much time to think and arrange your stuff.What i did was that i wrote the major sub topics-CC,HPI, PMH, family hx, etc and filled the spaces i left under them as points came to my mind. It is also a good practice to write the differential diagnosis and investigations first and then proceed tohistory and examination.
|
| drvic
Forum Elite
Topics: 10
Posts: 181
|
hi guys,
in my practice sessions i'm able to complete the PN well before time, say in 5 to 7 minutes at the maximum. but its the patient encounter where i keep falling short of time...i'm trying to follow the sequence spelled out by drmamu. my history taking is over by 7-8 min, and by the time i reach counselling my time is up. maybe i'm spendin too much time summarising the case or maybe in the examination...any suggestions...
___________________
say what you mean... and mean what you say...
|
| drmamu
Forum Elite
Topics: 43
Posts: 188
|
hai drvic,
its ok to feel short of time for both patient encounter and patient notes. I would say that if you finished things well ahead of time, you might have missed out somethings. Accept the fact that you wont be able to do all the examinations. But make sure that your sp does not realise that you areshort of time.Take history, examine and conclude ina reasonably sensible manner. Its ok to take 7min for your history. Take another 6min for examination and 2min to summerise and consel. take an example- Why dont you sit down and relax? We wil talk about your problems and treatments. So your main complaint is headache on the right side thatis aggravated by bending. You dont have any cough or nasal discherge. You are on treatment for dm and htn. Your examination were absolutely normal. All these are suggestive of sinus infection. We will do a couple of test to make sure of things. We will do some blood tests and an xray of th sinuses and a scan of your head. Once we get the results, we wil sit and discuss regarding the results and treatment. Is that ok with you? Is there anything you would like to tell me or ask me before i leave? Thank you very much. Take care.
I am sure you will be able to do this in two min. Some cases like Psychiatric cases, suicidal threats, domesti violence, terminal malignancy, etc. keep more time for counselling
|
|
| |
| | | | | | | | |
