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The Practice of Medicine II Academic Year 2011-2012

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The Practice of Medicine II Academic Year 2011-2012 Clinical Reference Manual Clinical Reference Manual Table of Contents Page Navigating the Medical Campus Standardized Patient H&P Checklist Guide to Writing Up the H&P (POM) Creating a Problem List and Differential Diagnosis (POM) One H&P Written in Varying Lengths Healthy Patient H&P Another Example of a Written H&P (POM) Excellent Student Write-Up Another Excellent Student Write-Up Clinical Abbreviations Common Laboratory Studies (POM) Cardiac Risk Factors ATP III Lipid Guidelines Guide to the Oral Presentation (POM) Writing Admission Orders Writing a Prescription Calling Report Guide to Writing the Progress Note (POM) Internal Medicine Clerkship – Formulating a Differential Diagnosis Internal Medicine Clerkship – H&P and Oral Presentation Guidelines Internal Medicine Clerkship – Intro to Professor’s Rounds and EBM Internal Medicine Clerkship – Model H&P Internal Medicine Clerkship – Model SOAP Note Geriatric Screens Pain Management Review of the Neurological History and Exam Neurology Clerkship – Written H&P Ob/Gyn Clerkship – Sample Written H&P Pediatrics Clerkship – Guide to the Pediatric H&P Pediatrics Clerkship – Sample Written H&P Pediatrics Clerkship - Sample SOAP note Psychiatry Clerkship – Guide to the Written H&P Psychiatry Clerkship – Sample Written H&P Surgery Clerkship – Sample Written H&P Clerkship Templates Researching Drug Information (POM) Electronic Resources for Clinical Questions Statistics and EBM Internal Medicine Telephone List Notes Practice of Medicine II: Navigating the Medical Campus An overview of the medical center • The Medical School is at the southeast corner • South Campus (blue) houses most of the inpatient wards (medicine, surgery, OB, etc) • North Campus (yellow) has most of the outpatient services plus Oncology and some surgery • Children’s Hospital (purple) faces Kingshighway TO GET ANYWHERE ON THE SOUTH CAMPUS: From the med school, go across the street to the hospital (the McMillan Hospital Entrance, which faces the Farrell LTC). Follow the very long carpeted corridor. You will pass the Vision Center on your left, then the chapel on your right, and then you will be at the central intersection (marble floor). From there you can go to various destinations as listed below. Barnes-Jewish Hospital South Campus Nursing Divisions for Hospital Sessions “100” Divisions (9100, 10100, 11100, 12100): Follow the very long carpeted corridor on past the marble intersection, all the way to the end. Take the Queeny Tower elevators to your floor. “200” Divisions (9200, 10200, etc.): Follow the very long carpeted corridor past the marble intersection. On your left (just past Medical Records) are the Rand-Johnson elevators, which will go to your floor. “300,” “400”, “500” Divisions (14400, 7500, etc): At the marble intersection, turn left. You will see the marble lobby with the fountain. Take the Central Elevators to the left of the fountain. (Admitting is off this lobby) Department of Internal Medicine, Kipnis & Moore Conference Rooms (6th floor Wohl Hospital) Follow the very long carpeted corridor to the marble intersection. Turn right. Go past the Barnes cafeteria, to the very end of the hall. On your left are 2 elevators for the Wohl Hospital. Go to the 6th floor. The Kipnis Conference Room is just to your left. On your right are a receptionist's desk and the Moore conference room. Wohl Clinics Building – Clopton Auditorium (lower level) and the POM Office (2nd floor) Follow the very long carpeted corridor to the marble intersection. Turn right. Go past the Barnes cafeteria, to the very end of the hall. To your left are the 2 elevators for the Wohl Hospital building, to your right, around the corner, is the Wohl Clinic building. In the Wohl Clinic building you will see a bank of 2 elevators, a stairway and a bank of 3 elevators; take any of those down 1 floor to the lower level and you will be in the lobby of the Clopton Auditorium. (On CPC days just follow the stream of white coats from the cafeteria to Clopton!) Tricks st o When in doubt, go back to 1 floor and get reoriented to the long east-west corridor o The Southwest Tower is across from the south campus cafeteria, just beyond the Barnard elevators ER – “Street” level SW Tower Cardiac Cath lab on 1st floor SW Tower (across from cafeteria, beyond Barnard elev.) The CT-ICU is on 5th floor SW Tower which connects to 7th floor Rand Johnson STANDARDIZED PATIENT HISTORY AND PHYSICAL EXAM CHECKLIST NOTE: The history and the physical examination must be tailored to each patient’s chief complaint and acuity of illness. These checklists would constitute a very thorough H&P in a patient with no particular complaints. The neurologic exam in particular can be quite expanded or abbreviated, depending on symptoms, PMH, and exam signs. Abnormal symptoms or signs warrant further evaluation. If you notice a limp then you need to do careful musculoskeletal and neurologic exams. Careful observation yields much information. As examples – if the patient mentions “my wife made me come” then you don’t have to ask about marital status. Watching the patient walk across the room and climb onto the exam table tells you a lot about gait, balance, strength and coordination. COMMUNICATION & INTERPERSONAL SKILLS The student did the following: Yes The student knocked on the door before entering The student introduced himself/herself to me appropriately, using my name to confirm my identity. The student maintained appropriate eye contact during the session The student allowed me to state my reason for being here without interrupting me The student asked concise and understandable questions The student told me about the Physical exam before starting to actually do the physical exam The student washed his/her hands before starting P/E The student draped me appropriately and respectfully prior to starting the physical exam The student maintained “draping manners” during P/E (by asking permission and explaining why before exposing any part of the body to be examined; and avoided examining me through the drape or gown). The student respected my comfort during the encounter by helping me sit up and get on/off the examination table, re-tied my gown (if the gown was untied by student during the physical exam). The student respected my comfort during the encounter by avoiding unnecessarily repeating painful maneuvers. Communicated with me throughout the course of the physical exam using language I could understand? Had an organized sequence in performing the different parts of the exam (i.e., minimized the number of times that I needed to change my position)? The student summarized the encounter findings (history and physical exams) with possible diagnoses being considered in terms I could understand. The student summarized the next steps for evaluating my problem in terms I could understand. The student asked if I had any questions or concerns and responded to them appropriately. Rate your overall level of satisfaction with the student encounter: Outstanding (i.e., I would seek out this person for my future care needs and would personally recommend this person to my friends seeking care) Very good (i.e., I would definitely return to this person for further care) Good (i.e., I felt adequately cared for & had no particular concerns about my encounter) Needs Improvement (i.e., I would prefer not to see this person again for further care) Marginal (i.e., I would specifically avoid seeing this person again for further care) Unacceptable (i.e., I would absolutely refuse to see this person again for further care and would personally advise my friends to avoid seeking care from this person) HISTORY - The student asked the following? Yes 2. Chief Complaint – the student asked if I had any complaints/problems today 3. History of Present Illness. The student thoroughly characterized my chief complaint. a. The student used open ended questions and did not interrupt my answers b. Describe the symptom (such as What does the pain feel like/the quality of the pain? What did your “dizziness” feel like?) c. For pain symptoms - Where is the pain? Does the pain radiate/spread anywhere? d. When did the (symptom) start? Did anything seem to trigger it? e. Is the (symptom) progressing, getting better or worse? Steady or comes and goes? f. What makes the (symptom) better or worse? g. When, if ever, has this occurred before? h. What are associated symptoms? i. How is this affecting your life/is it preventing you from doing anything? 4. About my past medical problems and for each medical problem: a. Time of diagnosis. b. Treatment. c. Complications d. Asked specifically about hypertension, heart disease, diabetes, and high cholesterol? 5. About my past surgical problems: a. Type of surgery and why performed b. When the surgery was performed. 6. For women: about my Ob/Gyn history: a. Age at first menstruation. b. Number of times I have been pregnant and number of deliveries. c. Whether I currently have periods. d. If so, whether my periods are regular, duration of cycle and duration of flow e. Date of my last menstrual period. f. If no periods, age at menopause? 7. About my medications: a. Dose. b. Frequency. c. About over-the-counter or non-prescription medications. 8. About my allergies: a. The specific allergic reaction. 9. About my social and occupational history: a. My current occupation. b. My marital status/living situation - Who do you live with? Where do you live? (Depending on the complaint: Who helps you when you are ill?) c. Habits: 1. Smoking. 2. Drinking. 3. Use of any drugs. d. Exposures. 1. Blood transfusions. 2. Exposure to Tuberculosis. 3. Any occupational exposures (dust, fumes, etc.). 10. About my family history: a. Whether anything runs in my family.
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