How to present a patient And asking for help How to present a patient Dr Mike Nicholls Emergency Medicine Consultant Auckland City Hospital April 2011

How to present a patient Difficult…balance between Difficult…balance between being exhaustive and being exhaustive and missing important things out. missing important things out. Opening statement is probably the most crucial Opening statement is probably the most crucial

Opening statement Requires a degree of synthesis / interpretation… Requires a degree of synthesis / 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 practice Requires practice

Opening statement Keep it relevant Name, Gender, Age Name, Gender, Age Location in ED Location in ED Past history (brief,relevant) Past history (brief,relevant) Meds (brief, relevant) Meds (brief, relevant) Presenting complaint Presenting complaint Consistent with Consistent with Degree of severity Degree of severity Management so far, response Management so far, response Plan (if, then) Plan (if, then) Question Question

Then…. Give a complete (or directed) hx/exam etc Give a complete (or directed) hx/exam etc Remember the obs Remember the obs

When speaking with another speciality registrar When speaking with another speciality registrar …usually to REFER (not advice unless specifically requested by your EM consultant). When speaking with another speciality registrar …usually to REFER (not advice unless specifically requested by your EM consultant). “I am Dr X, house surgeon in ED at Auckland, and I have a …year old (gender), Mr/Mrs (name),(+/- NHI) with (diagnosis)…., about whom I’ve spoken to my consultant and I would like to refer them to your service please.” “I am Dr X, house surgeon in ED at Auckland, and I have a …year old (gender), Mr/Mrs (name),(+/- NHI) with (diagnosis)…., about whom I’ve spoken to my consultant and I would like to refer them to your service please.”

When to discuss a patient with the boss When you are concerned When you are concerned Get help early Get help early Trust yourself Trust yourself Otherwise it varies… Otherwise it varies… between patient, shift, consultant, house surgeon between patient, shift, consultant, house surgeon Generally EARLY…6 hour target…we aim to make referrals before 3 hours Generally EARLY…6 hour target…we aim to make referrals before 3 hours

Discussing 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 please…” “When you’re ready, could I discuss this patient please…”

Discussing patients 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 than collect several patients over several hours. 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 than collect several patients over several hours. Not all the info is needed for a definitive plan to be made…so don’t necessarily need to wait for investigation results etc. Not all the info is needed for a definitive plan to be made…so don’t necessarily need to wait for investigation results etc. Aim for 3 hour plan ie decide admission/discharge at 3 hours from arrival to ED Aim for 3 hour plan ie decide admission/discharge at 3 hours from arrival to ED Find the consultant, don’t make them find you! Find the consultant, don’t make them find you!