发信人: Eye2011 (Eye2011), 信区: MedicalCareer
标 题: Re: STEP2CS 考经
发信站: BBS 未名空间站 (Sat Jan 22 16:03:36 2011, 美东)
THINGS I FORGET ALL THE TIME:
Write down the chief complain, sex, name and a list of DDX from the doorway
Knock 3 times with confidence, a smile, walk in (close the door behind) and
“Hello, Mr. (Ms) XYZ. I am Dr. and the physician on duty today. Nice to
(Shake hands) don’t shake hands with SPs in severe pain, pat on the
Then ask: “Is everything in the room all right for you?”
After that ... say... “Let me make you a bit more comfortable”
Saying this open up the drape ...OPEN IT COMPLETELY (cover the legs in the
beginning as it seems more courteous)
Start with ... “Mr. Xyz, may I ask you why you came to see us today?”
After that ....you say...”Oh I am so sorry to hear that. I shall try my
best to help you (smile). I will need to ask you some question and do a
brief exam in order to do that. Is that OK with you? Do you mind if I take
some notes while you speak?”
And after the patient say “yes”, write quickly the mnemonics.
Now ask the patient:
 Onset: When did it first start?
 Constant: is it constant or does it come and go?
 Duration: How long does it last? (If applicable)
 Preceding: Do you have any proceeding symptoms/events?
 Progress: is the problem getting worse?
 Aggravating: Is there anything that can make your pain worse?
 Alleviating: Is there anything that can make your pain better?
 Associated: Do you have any other symptoms associated with that?
When you finish with them...then start with questions specific for DDX.
After that... ask “Okay Mr. Xyz now I would like to ask you something about
your health in general. Is that okay with you?” (transitional Q 1)
PAM HUGS WA
 P Have you had similar problems before? Do you have any other
 A Do you have any allergies, including drugs, foods, chemicals,
 M Are you taking any prescribed medications? Are you taking any
 H Have you been hospitalized before? Have you had any surgeries
 U Have you had any problems with your urination?
 G Have you had any problems with your bowel movements or diet, i
.e. nausea, vomiting, constipation, diarrhea or change in stool color? If
there is vomit, ask for the color, smell and the presence of blood.
 S Do you have any problems sleeping or waking up?
 W Have you noticed any weight change recently?
 A How is your appetite?
After finishing off with "PAM HUGS WA", before you move on to "FOSS", it is
good to say, “The way medicine works; there could be some additional clues
in your personal information, which I’d like to ask. Is that OK with you?
Thanks. Let’s begin with your family history, OK?” (Transitional Q 2).
F Family history (similar chief complaints/serious illness)
• Does anyone in your family have similar problems?
• Are your parents alive? Are they in good health?
O OB/GYN history (LMP, period condition, pregnancy, abortions, Pap smear)
S “Mrs --- , now I would like to ask you few very personal questions
regarding your sexual health. Whatever you tell me will be kept confidential
. Is that okay?” (Transitional Q 3)
Sexual habits (active/partner number/preferences/STD...)
• Are you sexually active?
• How many partners do you have during last year?
• Do you use condom or any kind of contraception?
• Have you ever been diagnosed for STD/HIV?
S “Mrs --- , now I would like to ask you few questions regarding your
personal life style. Is that OK with you?” (transitional Q 5) Ask SODADE
for Social History
Do you smoke? If so, how many packs a day for how long? S
Do you work? What do you do? O
Do you use any recreational drugs? D
Do you drink alcohol? If so, how much do you drink per week? CAGE questions:
1. Have you ever felt you should cut down on your drinking?
2. Have people annoyed you by criticizing your drinking?
3. Have you ever felt bad or guilty about your drinking?
4. Have you ever had a drink first thing in the morning to steady your
nerves or get rid of a hangover (eye-opener)?
"Let me summarize here about your medical condition.…... Do you have more
information to share with me? Or do you think I miss anything?”
“OK. Now I need to perform a quick general examination and then look at
your heart - is that fine?"
"All right! Before we begin, Mr. (Ms.) Xyz, excuse me for a moment here so
that I can wash my hands"
Remember the patient’s occupation and commend on how wonderful that is
during hand wash to keep his/her attention.
Transitioning to a Physical exam:
Before you begin physical examination say "I will now need to perform a
quick general examination and then we shall have a look at your chest [or
abdomen - whatever the chief complaint is]" and do keep talking about what
you are doing during each thing your examine.
At the end of the entire general + systemic examination, summarize: Mr/Ms
XXX, based on your history and physical examination, we need to consider
several possibilities. There is a disease that caused (inflammation, lack of
oxygen, etc) in your (organ), in our medical term it is called (blahblah).
Right now it is first thing in my mind to consider, but it can also be
caused by some other situations. Such as 1._____, 2. ________ or 3. _______
and others. Therefore, we need to run a few tests on you. We have an
instrument which can give a rather accurate image for the structure of your
(blahblah); we are also going to do some blood tests. When the results come
back, we will have a better idea about what is going on, and decide how to
a. First, Counsel!!!
For a case of diabetes, it is good to say a few words on foot care!
If the patient smokes or drinks alcohol - say "Being a concerned physician,
I must advice you to limit the quantity of alcohol/tobacco and try to quit
it. Are you aware of the harmful effects of smoking / alcohol? Have you ever
considered quitting - if you wish to, we have a good support team that is
willing to help you quit the habit".
If they say no then say “I understand that it is very difficult to quit an
old habit and I know that you are not ready to quit smoking/alcohol yet, but
I want to assure you that whenever you are ready, I will be here to help
you. Please let me know if I can be of some help to you.”
For sex counseling you can say: “the reason why I asked you this is because
not practicing safe sex methods that include using condoms as well as
limiting yourself to only single partner puts you at higher risk of getting
STDs, HIV and cancer of the neck of your womb. As your concerned physician I
must advise you to observe safe sex methods”
For obese, hypertensive, diabetic, hyperlipidemic pts, advise lifestyle
change: healthy diet and regular exercise
b. Then "Have you understood everything we have discussed today?"
c. Then "Are there any special concerns you have?"
For difficult and challenging questions: make your own protocol for
“I understand your problem/concerns/ that you want to go for hiking/you are
"But right now it is difficult for me to say for sure as I need to run some
tests and once the results come out I will be in a better position to tell
you what we are dealing with.”
d. "Okay then Mr. Xyz. I am glad that I was able to work with you. Is there
anything I can do to make you feel more comfortable? If not, let’s meet
again when the test results are back. And I shall leave my contact
information - feel free to contact me anytime if you have any questions.
Thanks for your cooperation and it was really nice meeting you.” (Shake
hands) “bye now and take care".
※ 修改:·Eye2011 於 Jan 22 16:05:27 2011 修改本文·[FROM: 69.133.]
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