v*****u
发帖数: 74 | 1 不知道总结病史要详细到何程度? 以FA case 1为例写了一小段,诚请大家点评:
First let me summarize. You told me that you had burning, stomach pain for 2
weeks, especially after heavy fatty meals. Also you said that the pain
occurs at least once a day, 2-3 hours after meals. Is that right? On
physical exam I found your heart sounds good, belly sounds normal,
如何说 positive Murphy sign? | v*****u
发帖数: 74 | | m****d
发帖数: 156 | 3 I took the test 1 week ago. still waiting for the result yet, so the
following is just my opinion:
If you mean a complete closure by the example you gave, it's not enough yet.
use 2-3 sentences to summarize chief complaint is good. then give possible
diagnosis, one most likely and one alternative should be good. explain what
kind of disease it is. then counsel, WU, encourage for addtional qs.
Do not get yourself into trouble by trying to explain any + physical
findings. But do keep talking WHILE examining. 'you belly looks normal', ' I
do see you have pain when I press right here'. | j*******9
发帖数: 61 | 4 FA cs have 40 sample cases, I think we need to go through these 40 cases at
least. | v*****u
发帖数: 74 | 5 Yes, I want to write down each case.
Thanks med!
How about the workups, how many we should mention. Is that OK just always
say boold tests, and x-ray or U/S. | m****d
发帖数: 156 | 6 My rule of thumb: I would spend as long as I can on closure. The purpose of
closure is to confirm that you got everything right from patient; you have
some but not definitive idea on what's going on ; and you have plan what to
do next based on current clues. Do mention any workup if it helps to justify
your judgement: say you need do rectal exam because you suspect colon
lesion, you need do brain function study(auditory evoked potential) for the
cause of hearing loss. In fact, more goal-oriented wu impress sps more than
general blood and imaging studies. there's no need to cover all wu in
closure but make sure the ones you tell the patient are most pertinent ones.
Still, I don't think there's big problem give blood and imaging to everyone
if you can't think of any other in the last minute (usu. is the case xD).
【在 v*****u 的大作中提到】
: Yes, I want to write down each case.
: Thanks med!
: How about the workups, how many we should mention. Is that OK just always
: say boold tests, and x-ray or U/S.
| h**s
发帖数: 1757 | 7 I do not think u need to mention the + physical finding to the patient at
the closure.
I am still waiting my result , just look as reference:>))
My template of the closure:
Thank you for you cooperation, (smile)
Now I would like to give you a brief review your problem: you came to our
hospital because of ....,..., ... (3 + symptoms). is there anything else you
wanna tell me ?
Okie, thank you !
Based on the infor you gave me and my physical exam , I thought you might
have ...., or .... ( Give two diagnosis here is enough. the disease you can
give medical term or layman word, if you gave the medical term , explain it
in layman word asap). So I need run some test to find out what the problwm
is, such as....,.... After I got the result , I will in better position to
discuss the details with you. Do you understand what I told u? do you have
any other qs?
Thank you so much! please take care.
.....
Fot the wup, the most imp point is trying to give the fist and most useful
in clinic, not only general ones. | v*****u
发帖数: 74 | 8 Got it!
Thanks for the valuable suggestions,Med and hmis! |
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