becoming a consummate clinician (what every student, house officer, and hospital practitioner needs to know) how (not) to present a patient history精品.pdfVIP

PART 1 MEDICAL MUSTS AND MUST-NOTS: SIX ESSENTIALS OF WARD WORLD CHAPTER 1 HOW (NOT) TO PRESENT A PATIENT HISTORY Only connect. . . . — E.M. Forster (1879 – 1970), Howards End A doctor who cannot take a good history and a patient who cannot give one are in danger of giving and receiving bad treatment. — Anonymous , quoted by Paul Dudley White, M.D., in Clues in the Diagnosis and Treatment of Heart Disease (1956) For students, either you have already discovered, or will soon learn, that delivering a medical presentation on rounds is a challenging and sometimes terrifying experience. You have to satisfy two confl icting sets of goals simultaneously: accuracy and comprehensiveness vs. succinctness and effi ciency. THE HIDDEN HISTORY OF A HISTORY It is surprising how ineffectively and ineffi ciently many physicians, especially those in training, communicate clinical information. Clinical savvy, technical skills, and communication skills are not Becoming a Consummate Clinician: What Every Student, House Offi cer, and Hospital Practitioner Needs to Know, First Edition. Ary L. Goldberger and Zachary D. Goldberger. © 2012 Wiley-Blackwell. Published 2012 by John Wiley Sons, Inc. 13 14 HOW (NOT) TO PRESENT A PATIENT HISTORY necessarily positively correlated. A reliable sign of this problem is the restless legs syndrome or fl amingo sign (shifting of weight from one leg to the other) observable in colleagues visibly chomping at the bit to move on during seemingly endless presentations. For attendings, presentations by students and house offi cers can also be anxiety- provoking. As the ultimately responsible physi- cians, they need to integrate