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imagine this it's two in the morning you're alone in the er with a complicated patient and you need the help of your attending you pick up the phone you dial the number and you're nervous what the hell are you gonna say so he doesn't think you're an idiot hello and welcome to learnaboutize.com in this episode i'm going to teach you how to present a patient to your attending physician in the most efficient and professional way presenting a case is a key skill for every doctor and learning this early on will not only help you make a good impression with your superiors but also help you think in a structured way for every patient so that even the most complicated case is not a problem this video doesn't only apply to ophthalmology residents the same structure can be used for every specialty and it can be used to present patients on the phone as well as in person so let's go the main problem i see with my residents is that they're always so afraid to forget something important that they just tell me everything they know about the patient this usually leads to very long and complicated presentations so your first lesson should be if your attending is asking for more details that does not mean that your presentation was bad if he's asking for details that you already told him that means it was very unstructured here's the structure i want you to use pause the video take a screenshot and save it on your phone or memorize it we're going to go over each point in detail later on but first i'm going to give you an example of a bad presentation hi i just saw miss anderson she has a really red eye and she can't see much and she has pain it started a couple of hours ago when she was on the way home from her son's birthday party his name's sam by the way and funny story he's in med school and wants to become an eye doctor too so i took the pressure it's 56 and the angle is closed too i did an oct but the lids look fine and the retina as well so what should i do this presentation was completely unstructured and focused on unimportant details while leaving out important information so now let me show you how a good presentation sounds first we're going to go through it step by step and afterwards you're going to hear the whole thing at once hi this is lorenz always introduce yourself i'm a first year resident at the university eye clinic and i'm calling you from the er this part really depends on your situation i know all my residents by name so i don't need the job description but i like to know where they're calling from it's a huge difference to me whether you're examining an intubated patient in an icu or looking at a scheduled follow-up in a private practice i have a 45 year old caucasian woman two comments on that first of all please always calculate the age don't be lazy and just give the year of birth secondly always mention the gender the race may not be as important depending on the diversity of your patients presenting with blurred vision pain and redness in her left eye since two hours this is a part that a lot of young residents struggle with don't just repeat back what the patient said condense it down to the essentials let me give you a little example a patient might tell you i was watching tv last night do you know that show friends it's really funny right so all of a sudden i saw chandler twice at first i thought it was a special effect but then i noticed that the whole tv was double as well and the lab too and then i got up and i was walking like i was drunk isn't that weird so please don't tell you're attending any of that condense it down to i have a patient with sudden onset of double vision and balance problems eight hours ago one of the key skills of every doctor is to take a patient's story and convert it into a list of symptoms she has no other previously known health issues here i want you to paint a picture how sick your patient is but don't just list everything that you found out for example don't say well this patient had a zen implant in june 2015 and then a tribeculectomy in november 2015 and then a needling at the in december 2015 and another needling in february 2016 and then we did a blab revision in march 2016 and also again in march 2017. yes your attending might need all of this information later on but in your initial presentation you're just going to say i have a patient with multiple glaucoma surgeries i measured a visual acuity of 1.0 on her right eye and only 0.25 on the left the iop was 16 on the right and 56 on the left there's not too much to say about that part when you're listing measurements make sure you're always listing them in the same structure so always first right then left and emphasize with your voice on the ones that you think are important the slit lamp exam of her left eye showed a two plus conjunctival injection a hazy corneal stroma and a very flat anterior chamber the pupil is wide and unreactive to light this is the second part that most residents struggle with especially if you don't know what the patient has you tend to list every single thing that you've found if you don't know what is relevant here's a little tip take your list of symptoms and try to match them with your findings let's take this case as an example the patient has a red eye what structure makes it red is it a conjunctiva episclerosclero what's causing the redness is it bleeding is it hyperemia this patient has blurry vision so go through all the refractive parts of the eye and check whether there's a problem is it the tear film the cornea ac lens vitreous retina optic nerve or even the brain please leave out anything that has nothing to do with the symptoms if your attending needs more information he can ask about it as i said in the beginning it's not a sign of a weak presentation if your attending has to ask for more specifics it's only a sign if he asks you to repeat things that you've already said the right side looks pretty normal apart from also having a flat anterior chamber this kind of goes into the same topic as before if there's nothing to be found just say it's normal don't list every single thing that is normal and has nothing to do with the symptoms if i want more details later i will ask you about it the anterior segment oct i just did showed a closed angle on the left side now this part can be kind of tricky especially if you're new and you can't really interpret all the additional examinations that you make if you can try to interpret everything you've done if not take a screenshot or picture and send it to your tending in my opinion we're dealing with an acute angle closure attack i think we should give the patient diamox and pilocarpine and check the pressure and cornea again in one to two hours what do you think this part is very hard for beginners but i strongly urge you to always write down what you think the diagnosis is and what you think we should do as a treatment because believe me if you never do it one day you're gonna sit alone in your private practice and you're not gonna know what to do with your patient if you're not sure what exactly the problem is at least try to define a category is it infectious inflammatory genetic and if you have no idea what the treatment could be at least suggest what type of medication could help here steroids antibiotics whatever just a quick additional note please don't call your attending in the middle of the night before having done all the necessary examinations and before having read about the case in your book okay that was already it i hope you learned something and before i played a whole presentation for you in one piece please don't forget to subscribe like the video and hit the notification bell icon if you have any more questions please don't hesitate to ask in the comments below the video see you in the next one hi this is lorenz i'm a first year resident at the university eye clinic and i'm calling you from the er i have a 45 year old caucasian woman presenting with blurred vision pain and redness in her left eye since 2 hours she has no other previously known health issues i measured a visual acuity of 1.0 on her right eye and only 0.25 on the left the iop was 16 on the right and 56 on the left the slit lamp exam of her left eye showed a two plus conjunctival injection a hazy corneal stroma and a very flat anterior chamber the pupil is wide and unreactive to light the right side looks pretty normal apart from also having a flat anterior chamber the anterior segment oct i just did showed a closed angle on the left side in my opinion we're dealing with an acute angle closure attack i think we should give the patient diamox and pilocarpine and check the pressure and cornea again in one to two hours what do you think