 Presenting patients, part one. All right, guys, what is going on? Luxury from the MD journey, helping you succeed on your medical journey with less stress. This video is going to be part one on how to present your patients. I've actually made a video on this before, but it was more of a tips video than actual structure. So we're gonna do two parts of this. If you're new to this channel, welcome first of all, I'm a fourth year medical student. So I am wrapping up this journey. I'm gonna give you all the tips that I have on how to be a successful pre-med as well as a medical student. And part of it is how to present your patients well. If you can do this really well on your rotations, you are gonna look like an all-star from the very beginning. And I wanna teach you the structure that I've done before. If I have time, and if I might find the screenshots, I'll put a few of my evaluations, which kind of just talk about how my presentation skills have progressed. I think that's one of the first things I picked up just cause I had some clinical experience before starting rotation. So I'm gonna teach you kind of what's important, what to keep out, and then kind of how to sound like you know what you're talking about. Faith confidence is key when it comes to rotations. So we're gonna do this in two parts, like I mentioned. And the end result is you're going to be able to present really well on your rotations. You're gonna kind of know what to include, know what not to include, and you're going to be able to gather everyone's attention. You're not gonna be that student that's going to just lose the attention of the attending and the resident within the first couple of minutes. So don't let that be you, watch the rest of this video, and then watch part two. So part one is going to be kind of how to gather your subjective. Part two is going to be how to do your physical exam and then all the way up to your assessment and plan, which is the most important. But you need to understand this part to get to that one. So part one, start with the subjective. So the first part of your presentation is coming up with your one-liner. I know many of you guys are familiar with this term, but I'm just gonna act like you aren't, and your one-liner involves what I like to consider my who, what, and when structure, which is who is the patient, what the hell is wrong with them, and when did this start occurring? So for example, Mr. Johnson is my 65-year-old male that I use in almost all my examples, and he is here with a past medical history, so also that includes the patient's who. He has a past medical history of heart failure, hypertension, and diabetes, and he is here for what? He is here for chest pain, and he's a complaining of when, so kind of how long it's been going on. He's been doing complaining of this for three days. Mr. Johnson's a 65-year-old male with heart failure, diabetes, and hypertension comes in with chest pain for three days. So boom, you are already out of the gate rank. And so your one-liner is really important, and the one thing to understand about your one-liner is from this point on, every student kind of likes to get confused on what to include, what not to include, and also they struggle with the flow. First, before you even begin your presentation, think about your end result. What are you going to tell them that you think this is? Do you think this person with chest pain has a heart attack? Do you think that this person with chest pain has a heart failure? Do you think it's not really a big of a deal or do they have a pneumonia, whatever it may be? As soon as in your head you start thinking of what the patient has, you're already kind of moving forward to part two of this video, which is the diagnosis and the assessment and plan. As soon as you get yourself in the mind frame that I'm going to tell the story and I'm going to just start giving spoilers. I'm going to be giving hints here, hints there, and if you tell it like a story, act like it's a short little movie clip of the patient's life. Everyone that's listening is just more entitled to listen because they're listening for those clues as well. But if you say everything with the same amount of importance or lack of importance, then you're just kind of like, well, patient is here, three days of chest pain, and you go through the little old cars method that we've all learned, everything is boring. No one's going to listen to you and your presentations are just going to be lacking and it's going to take some time for you to pick up how to actually do it well. So instead, as soon as you finish your one liner, you want to start everything else from this point on to reach your end goal, which is to convince your attending and your resident, whoever else is listening, that your diagnosis and your assessment of the plan is right. So keep that in mind. That will kind of help you include things in the history and also exclude things if they're not so important. So let's say we think that this patient has heart failure. Okay, so he's complaining of some chest pain for three days and in addition, now we start the history. So the first thing you do is you basically briefly describe what let the patient come to the hospital. That's really important because a patient may be having symptoms for six months, but then you really want to know why they came to the patient or came to the hospital or the clinic that day. So you can say Mr. Johnson's been having some chest pain, which is pretty normal for him, but he's noticed that the chest pain, which he describes as a pressure like feeling on his chest has kind of moved throughout his body and now he has some swelling on his legs. He's having some issues breathing. He's coughing and it's gotten the worst to the point where yesterday, normally where you can sleep at night, yesterday you could end the news having trouble breathing. So now he came this morning to the hospital. That kind of breaks it down. You're already leading them down to a patient with heart failure. You're telling them the symptoms they had. Why led them to kind of say, okay, you know, crap, like I'm unhealthy, I need to go see a doctor. So that's kind of how you started off. I just briefly say, I'm gonna briefly tell you a story and this is kind of what it is. Then you move on to the old cards thing that many of you guys may have learned about, which is the first question is like, when did it start? So you kind of mentioned that in your one-liner. The second question is if it's pain, where is it located? Especially like chest pain, abdominal pain, location is key. It's located, you know, mid-sternally. That's how you describe a heart attack. Then duration, like how long does it occur for? Does it occur for 20 to 30 minutes? Is it constant? And, you know, how long has the pain been going on for? So it occurs frequently for 20 to 30 minutes but going on for three months. So that's kind of so onset, location, duration. And then kind of moving down, I'm not gonna list the whole old cards thing but you wanna go to things like characteristics. Ask the patient like, what does it feel like? Severity, like how bad of scale on a one to 10 is it? Compare it to your normal. Just go down the list of the old cards and I'll link down below to like a picture that you guys can see. Maybe I'll just put it right here so you can see what the old cards is. But go down those and that way you're attending can quickly realize that you've at least been diligent. But again, you don't have to mention everything. If your patient's not in pain, you don't need to say their location or their pain is non-existent, right? So don't do all of old cards if it doesn't pertain to your patient. Then get on to your review of systems. You've taken their history, you do a quick review of systems. People do this at different parts of a presentation. Some of them do it at the very end of their subjective which is what the initial part of your presentation is called. And then some people do it kind of in the middle. I like to do in the middle because I'm going to say this is what the patient is complaining about. I asked them additional questions just to see if they had any other things. So are they having shortness of breath? Yes. Are they having any abdominal pain? Are they having diarrhea, nausea, vomiting? Are they sweating? Are they having a fever? And you can just say patient after you asked the patient these questions you can say on review system patients said they had shortness of breath. They had nausea, vomiting. They had no sweating and no abdominal pain, no diarrhea, no constipation. Boom. You're done. You already told the attending. You've asked the questions in this area. You can also add things. For example, if somebody comes in with chest pain you wanted to tell the attending you thought about the other things that they could have. So maybe instead of a heart attack they have a pulmonary embolism or they have an aortic dissection. So you can ask them like have patients says they haven't had any histories of travel. No pain in their legs. No pain when they take a deep breath in. No, that's called pleuritic pain. And so your review systems is not just an opportunity for you to kind of ask all the questions and cover your bases. It's also an opportunity when you present it which is different. When you present it you wanna say positives that you looked for just in case it was another diagnosis. And then you want to look into presenting the negatives or saying, well, I thought it could may have been a PE. And so I asked him about whether he had swelling in his legs or pleuritic chest pain. He said, no, your attendings are like the student knows what he's talking about and he's already took that off my differential most likely. So you do the HPI, the present history of the patient. You do the review systems and then you get onto some of the important parts. So past medical history, this is kind of like what diseases do they have? Diabetes, hypertension. And in addition to just asking them, do you have it? One ask them, are you compliant with your medications especially diabetes and hypertension? Patients have a tendency of not taking them so you wanna make sure if they are. And then you want to get an idea of the severity. So diabetes, you can say, what's your most recent blood triggers? What's your most recent A1C? And then ask them about any complications from diabetes that you know about. So do they have any neuropathy? Do they have any issues with urination? Do they have any issues with their eyes? Do they get their eyes checked? Heart failure is a great example. So for example, you can say, you have heart failure. How many pillows do you sleep with under night? Because maybe they just have so much swelling and fluid in their body that they kind of have to elevate themselves to sleep comfortably. How many pillows do you sleep with? How far can you walk normally without losing breath? And then if you can walk a block without losing breath, how far can you walk today? And so you're telling your attending not only does he have heart failure, but normally he sleeps with one pillow. Yesterday night he slept with three and he still couldn't sleep. Normally he can walk a mile. Today he can walk half a block without losing breath. You're telling them this is their history, but this is how it's gotten worse. So past medical history, both what they do, are they compliant and the severity of it? And then you can get onto some of the things that are a little bit not as important depending on the rotation you're in. So surgical history, I mean, so ask it. Ever so often that becomes important. Their family history, you know, if they have heart disease for the first time or something that may be cardiac related, you wanna know if anyone else in their family has had it. And then you get on to things like medications. A great thing to do is when you're taking their H&P, you just have their list of medications next to you and already kind of written out. So you can kind of cross them out as you go and you can know which ones a patient is actually taking versus the one that the electronic medical record may be saying that they are. So you get to medications, ask them if they have any allergies and then move on to the social history, which is probably the last most important thing of your subjective, which is what does the person do for a living? You know, who do they live with? Your attending may wanna know that. And normally we just ask about some of the triple negatives, which is do they smoke? Do they drink? And do they do drugs? Those are important to ask, absolutely. And make sure you do, but make sure you know what they do for a living. Make sure you know who they live with in case the patient becomes kind of a social work issue as well in terms of discharge or insurance. And then ask them like the anything, if it's pertaining, you know, ask them things about like sexual activity, safety at home, things that sort. So I know that was a lot, but I'm gonna go through it one more time because that's the subjective. Part two is going to be a little bit more detailed on showing off that you know what you're talking about. But you have your one liner, so who, what, when and how? So who is it, what do they have, when did it occur and how long has it been going on? Get into your HPI, but only include the patient's description and then make sure you refer to why they chose to come today, especially if it's going on for a while. Do your review of systems, but when you present it, don't present everything, only present positives, which are related to a potential diagnosis and negatives which are related to a potential diagnosis. Move on to your past medical history and include what they have, whether they're compliant and severity of it and compare that to today, medications they take and you know, allergies that they have, surgical history, family history, social history, hit the big three, but also hit their occupation, home, home life, domestic violence potentials, as well as sexual activity. And that pretty much covers the subjective part of the presentation. This is the part where students spend an extensive amount of time and we struggle with because people stop paying attention to what we're saying. So instead, make sure that you do it with a very structured plan in mind and go back to what I said at the start of the video, which is you have an end diagnosis, you're trying to convince everybody that you believe that the patient has. So make sure that your story kind of points them in that direction. If you can do that, your subjective is going to be on point. Now you need to learn part two, which is what do you talk about on the physical exam? What do you include? What do you not include? This is the part of the presentation where everyone just checks out. So make sure you watch part two so you understand how you gathered everyone's attention through the first part of your presentation and you want to make sure that everyone is still paying attention. So don't lose them on the presentation and then your assessment and plan is where you make the money and where you get your honors evals. So make sure you watch that part as well. So I will link that part two down below once it's out. And otherwise, if you guys have any questions, comment below, like this video if you enjoyed it. Make sure you subscribe to the channel if you enjoy this content and you want more videos just like this one. But otherwise, I'm gonna stop babbling. I will see you guys in the next video. Take care, my friends.