EmergencyPedia

Case Presenting

You are asked to briefly present the patient case you have just see on the ward round.

The consultant insists that you start with a concise summary of the patient’s care.

Presenting cases is both nerve inducing and challenging – but we have to start some where.

A snappy opening statement and summary not only leaves a good professional impression but is also very important in long case examinations and OSCE stations where presentation skills are expected.  Presentation skills are often assessed in these Exams as a part of the marking criteria so practice is important.  Furthermore, in Medical Emergencies when calling for help concise and accurate presentation is also very important.

These two essential skills do overlap but we will tackle the “stable” healthy patient and “unstable” critically unwell patient with separate approaches…

Depending on the acuity of the situation you should give a different ‘style’ of presentation:

Two Styles of Presentation

• Unstable
  • If the patient is critically unwell or requiring early review and treatment brevity is very important
  • Before you call ask yourself – what do we need from the person I am calling?

• Stable
  • In a stable ‘long case’ discussion then style and substance are required
  • In the stable patient there should also be a focus on the patient’s social history
  • When presenting a long case be sure you have obtained an accurate chronological order of events from the patient and addressed their patients Ideas, Concerns and Expectations

Stable Patient

Here is our guide to basic presentation skills for a long case:

We recommend giving a basic 30 second overview including a ‘social snapshot’, most important presenting complaint and relevant past medical history of the patient:

• Introduce yourself as a medical student who would like to present a summary of a patient history

• State the patient’s identity and age:

I had the pleasure of meeting Mr Smith who is a 60 year old gentleman

• Mention a ‘social identifier’ or two:

Mr Smith lives with his wife and son and is a retired coal miner and has come to the hospital today for the purpose of the long-case examination

• State the Presenting Complaint(s):

Mr Smith states he presented to hospital one week ago with the following problems:

– Firstly, Intermittent Pleuritic Sounding Chest pain for the last 2 days

– and Secondly, a gradual onset of Shortness of Breath for 3 days 

• State the Relevant Past Medical History and Main Concern:

The patient has a relevant past medical history of Asbestosis and Emphysema

He is worried about what his new diagnosis of pulmonary embolism means for his future travel plans

In more detail…

• Finish your introduction with the phrase ‘In more detail‘ before presenting the detailed presenting illness and the rest of the history in a systematic order.  Using careful pauses and short phrases such as “in more detail”, “moving on” and “in terms of the patient’s family history” can really help sign post the presentation for the listener.

• Talking reasonable quickly is ok as long as you have good pauses to help the listener digest the information

• In general, try to avoid abbreviations, jargon and overly rushing your introduction

• If you can make some eye contact but avoid overuse of hand gestures

• When I am nervous I consciously slow down and shuffle my papers slowly on the desk while I collect my thoughts

Unstable Patient

This is the situation where it is very important to be brief in your handover.  Grab the listeners attention by introducing yourself and emphasising why you are calling and what you believe is required for the patient.

ISBAR, SBAR and ISOBAR are widely used communication tools that are easily learned and applied when handing over a patient.  One of the key parts of ISBAR is the ‘R’ which stands for ‘recommendation’ or ‘response’.  This part of the handover mandates that you make a recommendation of what should happen now and what response you want from your senior colleague.

Conclusion

In conclusion, preparation and planning is key to a smooth medical presentation.

Practice a formula that works for a discussion with a senior for a stable patient (Long-case) and a method that works for an acutely unwell patient that needs urgent attention (ISBAR).