A Medical H&P - Example 1

[@Ph.Tran88]

I’m obsessed with your videos! Learned so much

[@omidahomi712]

Thanks Dr. Strong. This is excellent for me entering clerkships soon. Keep em coming!

[@GDSchaefer]

Thanks for making all of these videos, I find them very informative even if the info often frequently beyond my EMT scope of practice. Would you be able to make a video discussing what the best EMS handoff report (both for trauma and sick IFT pts) practices are? What info an ER doc would want and how to best organize the information? I would be very interested in hearing what the people GETTING the report want to actually hear.

[@StrongMed]

Thanks for watching! I'm sorry, but I don't work in the ED and am never in the position to take signout from an EMT. It's a great question, but I wouldn't be the best person to answer it.

[@juliachambers725]

I do listen EMT giving report on the intercom sometimes and sometime it’s choppy and leave ED stuff puzzled as to what happened what is the major complaint what’s done and set of vitals presence of IV. I’d say talk to every doctor in ED you see (ask what you did right what to do next time, etc). They want you to do your best as well. EMS pips are such hard workers. I just met a great bunch of paramedics that delivered a baby. They bring stemies, strokes, trauma, etc. I know you got a love doing this for not much. The only advice make sure they have their teeth after intubation. My patient came in with missing front tooth and we still can’t find it. It was a hard intubation. Could have been ED as well but she has speech to give and tooth is missing.

[@heminhimdad]

Amazing video as usual, thanks so much ❤️❤️❤️❤️

[@yasminyouyuo]

Thank you Doctor ❤❤ I got excited seeing a new video from u

[@warbler1984]

Great video but I would say that a busy intern would not present a case in 5 minutes in any practice that ive seen...a bust service would be far shorter

[@StrongMed]

Thanks for the comment. I think it depends on the situation. If I'm rounding with the team and there's a new patient I've already seen myself or for whom I've reviewed their chart (the majority of patients for me), then I will usually tell the intern to give me a "SOAP style" presentation (as opposed to an abbreviated "H&P style" presentation). But if I'm coming into rounds knowing nothing about the patient, a presentation shorter than the 3-5 min range is too short to convey enough info to judge the assessment and plan. Are there hospitalists who truly want a presentation in the format of an H&P but delivered in 2 minutes? Yes, I know some who do. But I also think it's a mistake. If rounds are using the presentation as a communication tool, it's not enough time to communicate sufficient info, and other team members will need to read through the chart later anyway. And if rounds are using the presentation as a tool to assess the learner's clinical reasoning, it risks reinforcing behavior in which too little information is incorporated into the reasoning process. For example, if the attending never wants to hear the social history, it implies the social history isn't important. Over time, the learner will excessively deemphasize components of the social history in their reasoning process, or will stop asking about it altogether. I can't count the number of times I've asked an intern what a patient does for a living, where they live, or who they live with only to discover the intern has no idea.

[@warbler1984]

​@StrongMed thanks for the reply. I think you're so right about the social history and how it trains you not to include it but forgetting it leads to all sorts of disposition problems. I certainly wish these videos were here when I was a student!

[@dg12344]

I would spend more time in excluding DDs for progressive exertional dyspnea and peripheral oedema. "She reports no orthopnea,PND or associated exertional chest pain.She also reports no reduction in UOP/frothy urine,no yellowish discoloration of eyes and no overt bleeding manifestations.She also has no long term cough or wheezing.' Doesn't take a lot of time to say that.

[@TheoneandonlyRAH]

love this doc. tyvm

[@yazinuwa0123]

Wow thank u ❤