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Chapter 7: THE MINUTE(S) BEFORE THE INTERVIEW
Ten steps to perform in these one or two minutes before the medical encounter:
1- Have a new blank sheet on your clipboard/ booklet.
2- Put your sticker(s) on your left hand index finger (or on your answer sheet).
3- Write down: Patient’s name (if a child; also; accompanying person’s name and his/her relation).
4- Write down: Patient age.
5- What is the setting?: Use abbreviation, such us - Your office? write OFF;
- Walk-in clinic? write WC;
- Covering a colleague? write CC;
- Emergency Room? write ER.
6- Identify the station type: Use abbreviation, such us - History Taking? write Hx;
- Physical Examination? write PE;
- Consult? write CON;
- Combination? write Hx & PE, Hx & CON - Emergency? write ER. Then which ER type:
- Management? write MANAGE.
- Post acute phase/ after management by others and stable now? write Consult.
- Any of the above: Hx, PE, Hx and PE.
7- Identify the Chief Complaint (CC) / Consult subject and duration if given
write it down.
8- Write down any given findings (Circumstances, vitals or labs).
9- Identify the CC body system(s)? write it down.
10- Remember the station(s) appropriate questions box and differential diagnosis (DDx).
On the whistle/ buzzer/ bell: Knock the door and go in smiling,
calm with shoulders up. (Show confidence and friendliness)
The History Taking Interview: The Minute(s) Before
TIPS:
- Practice this step.
- Memorize the ten steps in sequence.
- Get blank papers and a clipboard or a pocket booklet just like the one you use in the exam. Check your exam official site to know what kind of papers will be given in the exam.
- Find a door at your home leading to a small room. Any door.
- Wear a lab coat and decide where are you going to put your pencil, stickers, stethoscope, pen light, hammer, measuring tape, the notebook and any other instruments asked to bring with you. Select places according to your
connivance and rapid access.
- Practice to take out these tools use them and put them back at the SAME place you decided to do. This is very important. As in exams, you will be nervous and you will forget where are these tools and will start looking for them nervously wasting valuable time and showing the examiner and the patient that you are not organized and don’t know what to do next!
- Take the blank papers and decide how are you going to organize it. Where to write the eight required information like the name, age, station type, etc. It is important to stick to the same format for quick access.
- It is very important to write every thing as you will be amazed how quickly you will forget them during the encounter due to the exam’s fast pace and nervousness.
- Place a peace of paper on the door with a stem question written on it. Get stem questions at OSCEs Home athttp://www.oscehome.com.
- Practice the ten steps over and over and over until you feel you are doing them naturally and confidently.
- Don’t worry about how long it takes to do it at the beginning. Just master the steps first. Then, with time try to be faster and faster to finish it with ONE minute.
- After you master it. Do it in front of family members or study group. Ask them to criticize you honestly and freely. Ask them about your nonverbal communication, gestures, standing position, head position and look Accept critics openly and adopt changes. Check OSCEs Home communication skill page at http://www.oscehome.com/Communication-Skills.html.
- Practice and practice and practice. Never underestimate the importance of acting and living the steps. Don’t tell yourself that you will do so and so, DO IT. Just do it. You can do it !
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Chapter 8: THE SELF-INTRODUCTION
Ten steps to perform in this stage of the medical encounter in 15 seconds:
1- Give the examiner your sticker, smile and move on (if applicable).
2- Approach the patient while smiling and relaxed.
3- Identify the patient: “Mr/Ms…..?” in a questionable tone.
4- Establish a sense of privacy: Draw a curtain / close the door / suggest that a visitor wait outside (Accept the patient decision).
5- Introduce yourself confidently, softly, friendly, comfortably:
“Hi, I am Dr …….…(last name)”. Shake hands, if you want (Preferred).
6- Mention your position: one of:
- in your office: nothing more.
- in a colleague clinic: “I am covering for Dr….today”.
- in a walk in clinic / ER: “I am the physician on duty here today”.
7- Ask the patient about how he/she would like to be addressed:
“Mr/Ms….., how would you like me to address you?”
8- Quickly screen the room: Where is the patient, your chair, stretcher, and TOOLS. Tools in the room are more likely meant to be used.
9- Ask the patient to sit down (pointing where) if he/she is not already sitting or lying on a stretcher. “Be seated/ lie down(if needed) here please.”
10- Then sit down. Don’t move the chair closer to or away from the patient.
Ideally about a meter far and in a narrow angle.