How to present a patientHow to present a patient

And asking for helpAnd asking for help

How to present a patient

Dr Mike NichollsEmergency Medicine ConsultantAuckland City HospitalApril 2011

How to present a patientHow to present a patient

DifficultDifficult…balance between …balance between being exhaustive and being exhaustive and missing important things out.missing important things out.

Opening statementOpening statement is probably the most crucial is probably the most crucial

Opening statementOpening statement

Requires a degree of Requires a degree of synthesis / interpretationsynthesis / interpretation…… can’t just give all the details without any degree of thought.can’t just give all the details without any degree of thought.

Requires Requires practicepractice

Opening statementOpening statementKeep it relevantKeep it relevant

Name, Gender, AgeName, Gender, Age Location in EDLocation in ED Past history (brief,relevant)Past history (brief,relevant) Meds (brief, relevant)Meds (brief, relevant) Presenting complaintPresenting complaint Consistent with Consistent with Degree of severityDegree of severity Management so far, responseManagement so far, response Plan (if, then)Plan (if, then) QuestionQuestion

Then….Then….

Give a complete (or directed) hx/exam etcGive a complete (or directed) hx/exam etc Remember the Remember the obsobs

When speaking with another When speaking with another speciality registrarspeciality registrar

When speaking with another speciality registrar …When speaking with another speciality registrar …usually to usually to REFERREFER ( (notnot adviceadvice unless specifically unless specifically requested by your EM consultant).requested by your EM consultant).

““I am Dr X, house surgeon in ED at Auckland, and I have I am Dr X, house surgeon in ED at Auckland, and I have a …year old (a …year old (gender)gender), Mr/Mrs (, Mr/Mrs (namename),(+/- NHI) with ),(+/- NHI) with ((diagnosisdiagnosis)…., about whom I’ve spoken to my consultant )…., about whom I’ve spoken to my consultant and I would like to refer them to your service please.”and I would like to refer them to your service please.”

When to discuss a patient with the When to discuss a patient with the bossboss

When you are concernedWhen you are concerned Get help earlyGet help early Trust yourselfTrust yourself

Otherwise it varies…Otherwise it varies… between patient, shift, consultant, house surgeonbetween patient, shift, consultant, house surgeon Generally EARLY…6 hour target…we aim to make Generally EARLY…6 hour target…we aim to make

referrals referrals before 3 hoursbefore 3 hours

Discussing patients with the bossDiscussing patients with the boss

The boss is often busy (don’t be offended!)The boss is often busy (don’t be offended!)

For the “routine” patient For the “routine” patient ““When you’re ready, could I discuss this patient When you’re ready, could I discuss this patient

please…”please…”

Discussing patientsDiscussing patients

It is much more desirable for you to discuss each patient early (once It is much more desirable for you to discuss each patient early (once you have seen the patient and synthesised a plan of attack) rather you have seen the patient and synthesised a plan of attack) rather than collect several patients over several hours.than collect several patients over several hours.

Not all the info is needed for a definitive plan to be made…so don’t Not all the info is needed for a definitive plan to be made…so don’t necessarily need to wait for investigation results etc.necessarily need to wait for investigation results etc.

Aim for Aim for 3 hour plan 3 hour plan ie decide admission/discharge at 3 hours from ie decide admission/discharge at 3 hours from arrival to ED arrival to ED

Find the consultant, don’t make them find you!Find the consultant, don’t make them find you!