 What is going on guys part two of how to present your patient and do it successfully? Let's get to the video All right guys what is going on lecture from the MD journey helping you succeed on your medical journey with less stress This video is going to be part two of how to present your patient successfully now if you haven't watched part one I will put it up here You can finish the rest of this video and then get to part one or you can watch part one and then come Back to this video, but both of them are gonna be really important for you to kind of understand from start to finish what you Should do Regarding presenting your patients so that way you just look like an all-star on your rotations because then everyone's gonna understand that yep That student knows what he's talking about or what she's talking about so Let's get to this part Which is we're gonna talk about how to present your physical exam as well as how to present your assessment plan So I'm gonna try to keep this video shorter than the other ones so sorry if the other one was a little bit longer But we're gonna start with the physical exam and you want to make sure that you start with the vitals I feel like at least 51% of the students miss this one because we just want to we're just excited We just want to get to the cardiac exam for our chest pain patient That's what we were talking about in part one or a heart failure patient So you want to make sure that before you even start telling them who the patient is and or like what the patient looks like to you On an exam want to say what the vitals are they'll tell you you're attending how severely sick or not sick this patient may be so start with your vitals and Every attending wants is a little bit different. So make sure you go over with them How they want this part to be presented, but I'm gonna give you a structure and I'm gonna give you the other option as well So first you start with their temperature and you always usually always say a patient's febrile or a febrile If they're febrile obviously obviously say what their temperature was their a febrile They don't have to say that they're 98.7. Okay, that's just you know wasting time wasting breasts and you're just saying numbers so Say you know on physical exam for vitals a patient was a febrile then move on to their heart rate I like to do the last 24 Hours worth and so usually emr is able to like nicely track that for you and most students will do what I attend not like Which is they'll say Heart rate and this is just a little pet peeve, but I think most attendings start checking out here too If you pay attention, which is they'll say heart rate is from 83 to 117 um Just say the heart rate was 80s to 100 teens The patient was most recently tachycardic When they came to the emergency room, but now they've been in the 80s So you can also say you know patients a febrile Currently they're not tachycardic, but they were in the one teens when they came into the ed That that's much, you know You're trying to convince that you know what you're talking about You would you demand attention If you can say things that way if you just report data, you're just going to look like a reporter If you command your data, you're going to look like the manager that they want you to be of the the patient So getting that mindset. Okay, so they're a febrile. They aren't tachycardic right now, but they were In the 80s into one teens their blood pressure similar thing I like to do is I'll say the blood pressures have been stable to From the 90s to 100 in teens over 60 to 80s and then you can say they're they're breathing well on room air And you just move on, you know, you don't have to know you don't say their respiration is 22 or sorry You don't say the respiration is 18 And they're just breathing fine and they're o2 sats 100, you know, that only really matters if it's abnormal So ask your attending again because some attendings may want to make sure that you know everything Is presentable. They may want to make sure that you know actually to present it So ask them like, how would you like the vitals to be presented and try that structure out for the first time and see if they Are kind of off that they didn't include something but Again, you look like you're commanding more attention when you can say it like that because if you listen to your residents That's exactly how they present it And they're not doing it pertaining for speed. They just want to make sure they're painting the picture as what's important So, um, that's how you do vitals once more patients a febrile They're not tachycardic But they were in the one teens when they came to eds their blood pressures have been stable between the 80s and 100 teens Diastolics from 60s to 80s and they're breathing fine satting well on remair So then you get into what the patient Physical exam looks like so always start with how the patient looks, you know, if a patient is obese That's important mentioning if the patient's on a nasal cannula. That's important to mention If the patient is asleep and like stupors and they're not responding that's important to mention So you can say, you know, uh, in general appearance patient is well appearing They're not in acute distress and they're pleasant to talk to and they're alert and oriented times four So again, you're commanding attention versus just saying the generic phrase which a patient is, uh, You know, well developed to whatever Well groomed and no acute distress. That's just that's just boring and no one wants to listen to that So command attention be a little more not as animated as I am right now Make sure you just command each phrase and and then move on to other parts of their exam So you may do their hg and t Uh, you may feel for lymph nodes of a patient complains of like weight loss or something And uh, but let's get to some of the key ones that you'll probably talk about which is like cardiovascular Your respiratory and your abdominal. So you cardiovascular. This is again the boring way people, uh, present this They'll say on cardiovascular exam, uh, regular rate rhythm normal s1 s2 Uh, no murmurs gallops erupts like Okay, fine, you know, you you did everything you wanted to but again, you are now a reporter You are not the manager. There's the the patient So you can say on cardiovascular exam, you know, they had a regular rate. They had a regular rhythm I didn't manage to hear any murmurs. They're no less ones than s1s2s were, uh, they were fine And then I listened for carotid bruit. I didn't hear one I also checked their pulses distally, uh, and they're all two plus You see the difference is that you are presenting things as a conversation You're telling you're attending. I am talking to you like listen to me But if you were presented with the format and the little like plugin Phrases that we've learned throughout medical school. No one wants to listen Um, so try to take a little bit of a creative round how you present it in my My style and you don't have to use this is I just act like I'm talking to a friend You know act like how you talk to a classmate. You're not going to tell them normal s1s2 Um, you're going to present the data just because you have to but you're going to say it with a different Uh, of a structure just like how you naturally would talk Um, and that's kind of my takeaway for, uh, the presentation, uh, regarding the physical exam So make sure you don't include stuff that you don't need to so don't talk about their AT&T exam, uh, if They had nothing related to this part of their head. You can obviously do it But don't you don't have to include it in the physical exam unless they're attending asks you to mention later so Cardiovascular exam move on to respiration again, people will do cleared auscultation bilaterally no wheezes rails and No secondary movements, uh, but again, you can just say, uh, I listened to the, um, you know on lung exam I noticed that the patient had, um, decreased blood, breath sounds on the right lower lung faces But the rest of the lungs were cleared throughout. Um, and then you can just keep going from there so Keep the conversation on your abdominal exam. You want to say did the always remember, you know, listen before you Percuss if you palpate so the patient had normal bowel sounds You don't have to include that if it's not relevant like a heart failure patient That may not be relevant to talk about their bowel sounds, but listen to their bowel sounds Then palpate percuss as necessary, but you can say on abdominal exam was overall pretty benign normal bowel sounds, uh, no rebound tenderness and Patient didn't have any, uh, you know tenderness to palpation Um, again, if we're talking about a heart failure patient, you remember you need to present the part of the exam That's relevant to somebody with heart failure. So Using him as an example, this is how I would present I would say mr. Johnson, you know on general appearance He's a well-developed slightly obese and is breathing You know mildly uncomfortably currently on nasal cannula his cardiovascular exam Is slightly distant heart sounds but regular Right rhythm. No no murmurs heard and then his respiration exam I did hear some crackles on his lower lung bases And he does have some accessory muscle uses With his shoulders moving on to the domino exam. He was a little bit distended And then you just keep going that way I like to do head-to-toe presentation versus like body systems Most of it it works head-to-toe anyways, but like your cardiovascular exam You may also talk about whether or not they have any a demon, but you get the picture, right? You want to Be very conversational you want to present only what's important And again, you want to lead them in your final diagnosis, which in this case We're patient has heart failure. So I want to point them in that direction But that's the physical exam you want to do it in that structure Then you move on to you know labs and you want to get to imaging Similar I'm not going to you know beat the horse on this one You just want to say the important labs your your in case you're intending wants to know everything say everything But you're when you're telling your chemistries and when you're saying your sodium potassiums and whatnot You can read them out and you can just say their numbers You don't have to say potassium is 3.4 and sodium is like one 42 you can say 142 and 3.4 everyone that's heard that enough time knows that one number is definitely your sodium One number is definitely a potassium otherwise something severely wrong and so Ask your attending. Do they want to know just the relevant ones? Or do they want you to say everything and if so kind of expedite and say quickly You don't need to say their bilirubin If it's not relevant or if they're if their tsh was normal and you checked it just say their tsh was normal You don't have to like just report all the data Even some of the interns on my ic rotation were doing that and it just took forever to present So just try not to when you can be as relevant as possible Somebody may ask you what the data for the inr was if you forgot to mention it You can say oh, you know you still have it so you can say oh the inr was you know 1.7 so Present their labs do it in a pertinent way only report the things that you think you need to again Appointing them to the final diagnosis talk about their imaging um And try not to read kind of the word verbatim What the the interpretation of like an ekg or uh, what an x-ray said Make sure you understand what it meant and then say it in your words Because then again you sound like you're having a conversation So that is a nutshell the the physical exam and the lab and the information And then finally we get to the assessment plan So the way you start it again is you do your one-liner so from from before so from part one It's your who your what your why and your how so who is it? What's going on with them? You know or what do they have which is like what's their past model of history? Why are they here and how long has it been going on? So mr. Johnson is our 65 year old male with a past medical history of heart failure injection of fraction of 15 hypertension and diabetes Who comes in presenting with three days history of chest tightness as well as a lower extremity edema for the last three days um regarding his symptoms His physical exam is history. Uh, definitely a point to a picture of potential heart failure exacerbation exacerbation He had an infection Earlier this week's which likely may have been one of the causes and he hasn't been very compliant with his medication or diet Other things that i'm considering. I still am considering an mi considering a pe also um He had some mild tenderness when I pushed on his chest. So he may have some gastro-condryol pain as well. And so Regarding what I want to do for him. So that is your one-liner Before you kind of get on to your plan you want to say one-liner and then you add in like one more line, which is I like to phrase it, you know putting together his history and his physical I think this patient has other and this is why you know Given these situations from their history and physical. I think this patient has this Then say at least two more things that the patient could have that you're still rolling out So in addition, I think this patient could have x and y because of this and this For you know, this is what I want to do for them. Um, and then you move on to your plan for them Attendings do this part of the presentation a little bit differently So you can either present as a plan or as a problem base. So for their chest pain I'm doing this for their blood pressure. I'm doing this or you do this based off of organ systems Some people like to do it for for their cardiovascular. You know, they clearly have their chest pain Um, they have heart failure exacerbation history. And so you answer all those I'm going to do it I'm going to present this based off of your problem list. So you start with the top What's the most important thing this guy came in with chest tightness and came in with lower extremity edema Which we think is because of his heart failure. So I'm going to say his first problem is heart likely heart failure exacerbation So these are the medications I like to give him. These are the labs I like to order Move on next problem. He's also has hypertension And his blood pressure was a little elevated when he came in. So I want to make sure I control it And I'm going to start his whole medication of this keep going down the list Again continue to have a conversation Now you kind of pointed them to your diagnosis. You're just kind of wrapping in loose sense So add them to your problem list. If you're kind of confused on how to create a problem list There was a great video that most of my viewers enjoyed I'll link that up here and also down below in the description, which is how I keep my patients organized Which is going to really help with this whole video, which is how to keep it vital Is how to keep their physical exam how to keep their labs and then finally how to design Your problem list so watch that video to understand kind of how I create their problem list But once you have it just present them and then you want to wrap it up by saying Things like discharge so even as soon as you admit the patient get in the mind of what do you have to do for this patient to discharge them So things like PT has to come see a patient that can't walk really well Social work is going to have to see a patient that can't afford things You don't want them to see the patient the day you want to discharge them because then it's going to take another couple of days To expedite that process. So you can say this patient's here for heart failure but they don't also have finance to accept their medication and They're having difficulty walking around their two-story home. I'm gonna have PT come see them I'm gonna have social work come see them to tomorrow as well That way you're treating them for their medical condition and you're you know making sure that they have every all the the loose ends tied up So if you present the disposition you present their discharge at the very again You're just gonna look like an all-star because it tells everybody I know this patient is I know what they have and I know what to do with them from start to finish And you're gonna just kill it on your presentations Most med students will spend a majority of the time saying unnecessary data Saying unnecessary lab data saying unnecessary subjective and physical exam finding So as long as you can create a structure from start to finish again Watch part one if you haven't from start to finish where you're telling their story point them at your final direction Should you say the physical exam that's relevant to what is pertinent for that patient's complaint? And then you show the labs that again are relevant And you show your presentation or your plan in a way that shows very structured on what you're going to do And how you're going to send this patient home There's nothing left for you to do like if you're You're attending is going to be listening majority of the time and you're going to do great on your presentation So if you guys enjoy this, you know two-part series you want more questions Are you having more questions? Let me know comment below if so like this video again watch part one up here If you haven't I don't think it actually will come up here, but it will be in the description And I will also put the videos of the other ones that I mentioned such as how to stay organized on your rotations Put that all together do great on your 30 rotation Hopefully you guys enjoyed this video If so give this video a like and subscribe to the channel And I will be seeing you guys on a weekly basis with new video content But until then I will see you guys the next one. Take care my friends