Case Presentation
A case
presentation is a formal communication between health
care professionals (doctors, pharmacists, nurses, therapists, nutritionist etc.)
regarding a patient's clinical information.
Basic principles
An oral case presentation is NOT a
simple recitation of your write-up. It is a concise, organized recitation of
the most essential information. A case
presentation should be memorized as much as possible. You can refer to notes,
but should not read your presentation. Comparison should be made
with the given literatures to patients’
clinical features,diagnostic tests and treatment responses. Length –A full case presentation should be
between the range of 5 to 10 minutes.
Essential parts of a case
presentation include:
Patients’Identification
Reason
for consultation/admission
Chief
complaints (CC) - what made patients seek medical attention.
History
of present illness (HoPI) - circumstances relating to chief complaints.
v 90% of correct diagnoses come from the history alone; do not sabotage your
listener’s understanding of the case by omitting important information. The HoPI
portion of the oral presentation, as a general rule, should take 1/3 to 1/2 of
the presentation time. Common pitfalls include incomplete characterization of
the major symptoms, omitting pertinent negatives or positive findings, questions,
and omitting specific information about past history that relates to the
present problem.
Past
medical history (PMHx)
Past
surgical history
Ø
Provide a list of all prescribed medications and a list of any relevant
non-prescription medications.
Ø
Unless you have the chance to review the patient’s chart,
you will only be able to give as much detail about medications as the patient
can give you.
Ø Report any relevant drug allergies
and the type of reaction (for example, “the patient developed a skin rash
approximately 20 years ago after receiving penicillin and carries the diagnosis
of penicillin allergy”).
Ø Summarize substance
use which is not already mentioned in HoPI. However, f it has been mentioned in
the HoPI,do not repeat it.
Family
history (FHx)
Social
history (SocHx) (current situation and major issues only i.e. work, living
situation, and support systems, and any ongoing social issues, marital status
and personal habits if pertinent)
v General description – be colorful, allow the listener to visualize the
patient.
v Vital signs should always be mentioned, including postural changes if
relevant.
v Mention only the relevant positive findings and relevant negative findings.
An example of the latter includes (in the dyspneic patient) “the exam is
remarkable for clear lungs bilaterally.” Use concise but complete descriptions
of positive findings.
Case
summary and impression
Assessment and Care plan
Adherence
of the patient to treatment
Success
or failure of the treatment and nursing management
Causes
or success of failure if possible
Follow
up
Note: You must know all of the patient’s problems and include them in your
write-up, but presentation of problems which
are not relevant to the current active problems only distracts your listener.
Common
Mistakes in Oral Presentation
- Slow labored rhythm –
a. The ability to convert a written history and physical examination into a compressed
presentation requires careful thought and practice.
b. Ask your attending or facilitator how long a presentation they would like.
c. Maintain eye contact with your listener during the presentation, which
means that you should refer to notes and not read your write-up.
d. In order to keep it in time you will need to PRACTICE it two or three times
in advance. This is helpful to do with a classmate who can give you feedback
and then let you try again. It is also worth taping yourself and listening to
the tape –you would often give yourself feedback.
2. History
of present illness too brief
3. Failure to use parallel reference points - in both write-ups and
oral presentation, relate time in “hours/days/weeks prior to admission”. Avoid “at
2:00 in the morning of last Wednesday” or “on May 25th; instead, say “three
hours prior to admission”, or “at 2:00 am, three days prior to admission”.
4. Editorializing in the middle of the presentation - avoid comments
like “do you even want to hear this?…” or “cardiac examination revealed a
systolic murmur….well, I thought heard it, but the resident didn’t…so maybe it
isn’t there….I don’t really know….”
5. Use of negative statements instead of positive statements. Positive
statements add color and accuracy to your presentation. “Chest X-ray shows
normal heart size” is better than “chest X-ray shows no cardiomegaly”. “In
summary, this patient’s problem is acute dyspnea” is better than “the patient’s
problem is rule-out pneumonia”.
6. Repetition- vary your sentence structure. An overly repetitious
presentation is monotonous for the listener. “On pulmonary exam, the lungs were
normal…on cardiac exam, the heart sounds were…, on lymph node exam, there were
no cervical nodes…etc” is difficult to listen to and unnecessary – your
listener knows that S1 and S2 are part of the cardiac exam! Use brief
descriptive sentences.
7. Disorganization - this problem is a result of lack of rehearsal.
Stopping at the end of the HoPI to say “Oh, I can’t believe I forgot to tell you
this” will kill a presentation. Or “…in summary, this patient…wait, I forgot to
tell you the most important thing…” You need to be aware that this can happens
even with careful
preparation. The best advice when you forget something crucial to your
presentation, is to work it in as soon as possible and don’t make a big deal
about it.
8. Physical findings presented without proper terminology - for
example, “lymph node exam shows some small cervical nodes” is not as
descriptive as “…there were three soft tender mobile nodes in the left anterior
cervical chain .“ Commitment to accuracy will improve your physical examination
skills.
Note: (This guideline is uploaded and published after extensive study and consultation through seniors, collegues and various teachers. Any suggestions or reasons for unacceptance of this guideline is heartily welcomed. Regards and Thanks!!)
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