Presenting a Brand-New Patient
Admitting a brand-new patient to the hospital is the quintessential learning experience during your core clerkships. You should make your case for the patient’s diagnosis and management plan by including relevant information from the patient interview, exam, and diagnostic information. The presentation is meant to be about 5 minutes long. Depending on the complexity of the patient, the presentation can be lengthened when the attending provides additional input. Focus the content of your presentation based on the presenting symptom or concern, the patient’s history, and any additional information that may alter the patient’s hospital course. However, make sure to discuss presentation expectations with your seniors (resident or attending).
One-liner
Start your presentation by introducing the patient. Include the patient’s name, age, gender, pertinent past medical history, and chief concern. Try to only include the medical history based on relevance to the chief concern. The chief concern itself should be why the patient presented in their own words.
HPI
Typically, you should describe the events leading up to their presentation. This is also the section where you should highlight any relevant personal history from your review of the patient’s medical record.
Onset of patient’s symptoms
Provoking and Alleviating factors that make the patient’s symptoms better or worse
Quality of the symptom or how they describe it
Region, or location of the symptoms and Radiation, or if the symptom travels anywhere (typically to describe pain)
Severity of the symptom – for pain, this is often a number on a scale; describe other symptoms relative to baseline (i.e. short of breath after 5 minutes of walking compared to normally short of breath after 30 minutes)
Timing of the symptom(s) in terms of length of time a discrete episode lasts, how quality changes over time, if this is a recurrent or new issue
Associated symptoms, which may have different onsets and triggers
Any additional information that supports your most likely diagnosis or eliminates other diagnoses
Relevant ROS
This can include the associated symptoms or additional symptoms that are less relevant to their presentation but may affect their hospital course.
Relevant medical history
Describe the PMH, PSH, Meds, Allergies, Family Hx, Social hx (particularly substance use, sometimes occupation can matter) that could be contributing to their presentation or impact their hospital course. At some institutions, medications are reported after the objective information.
ED course
Report the initial vitals and any important results as well as the subsequent interventions. Some attendings may prefer this is reported after the objective data.
Objective
Vitals
Vitals provide important hemodynamic information and should always been included.
Physical Exam
For the first presentation, I recommend being more thorough: at minimum, I describe their general appearance, cardiovascular, pulmonary, abdominal exam, and mental status. In addition, include any other exam findings or special maneuvers that impact the listener’s differential.
Diagnostic studies
This includes labs (serum, urine, stool, etc), EKGs, and imaging. Typically, you do not need to review every result. Focus on results that narrow your differential.
Assessment & Plan
This is the most important part of the presentation. This is your interpretation of the patient’s case. Start with a synthesis statement that, rather than restating the chief complaint, summarizes the key elements of the history and objective data to support a possible diagnosis. Then describe the management for each medical issue by prioritization of the issues or by body system. A more detailed explanation and example of how to format the assessment and plan for each issue can be found in “Presenting a Patient Already Admitted to the Hospital.”
When you start delivering presentations, they will not be perfect. Your attending or resident may interject in your presentation for clarification or specific information. They will also focus on your assessments and plan by delving into other diagnoses, testing, or interventions to consider. If this happens, use it as a learning opportunity for information or conditions to mention the next time you present a similar patient. The more presentations you give, the better they will get so keep working on them!