Presenting Cases and Communication

Medicine is a subject in which you have to be able to talk.The more practice you get, the better you will become and the more confident you will appear in front of doctors, nurses and patients. Confidence displayed by the doctor is an important aspect of therapy and the value to the patient of a doctor who can speak lucidly is enormous. Practise talking to yourself in a mirror, avoiding any breaks or interpolating the word ‘er’. Open a textbook, find a subject and give a little talk on it to yourself. Even if you do not know anything about the subject, you will be able to make up a few coherent sentences once you are practised.

A presentation is not the time to demonstrate you have been thorough and have asked all questions, but is a time to show you can intelligently assemble the essential facts. In all presentations, give the salient positive findings and the relevant negative findings.

For example:
– In a patient with progressive dyspnoea, state if patient has ever smoked.
– In a patient with icterus, state if patient has not been abroad, has not had any recent injections or drugs, or contact with other jaundiced patients.

Three types of presentations are likely to be encountered: presentation of a case to a meeting, presentation of a new case on a ward round and a brief follow-up presentation.

Presentation of a case to a meeting
This must be properly prepared, including visual aids as necessary. The principal details, shown on an overhead projector, are helpful as a reminder to you, and the audience may more easily remember the details of a case if they ‘see’ as well as ‘hear’ them.
° Practise your presentation from beginning to end and leave nothing to chance.
° Do not speak to the screen; speak to the audience.
° Do not crack jokes, unless you are confident that they are apposite.
° Do not make sweeping statements.
° Remember what you are advised to do in a court of law—dress up, stand up, speak up, shut up.
° Read up about the disease or problem beforehand so that you can answer any queries.
° Read a recent leading article, review or research publication on the subject.

In many hospitals it is expected that you present an apposite, original article. Be prepared to evaluate and criticize the manuscript. If your seniors cannot give you references, look up the subject on the internet or in large textbooks, or ask the always helpful librarian for advice. Laboriously repeating standard information from a textbook is often a turn-off. A recent series or research paper is more educational for you, and more interesting for the audience.
Presentation of a new case on a ward round
° Good written notes are of great assistance. Do not read your notes word for word—use your notes as a reference.
° Highlight, underline or asterisk key features you wish to refer to, or write up a separate note-card for reference.
° Talk formally and avoid speaking too quickly or too slowly. Speak to the whole assembled group rather than a tête-à-tête with the consultant.
° Stand upright—it helps to make you appear confident.
° If you are interrupted by a discussion, note where you are and be ready to resume, repeating the last sentence before proceeding.

People—including patients

A significant number of disasters, a great deal of irritation and a lot of unpleasantness could be avoided in hospitals by proper communication.
The doctor is not the boss but is part of a team, all of whom significantly help the patient. You must be able to communicate properly with the nursing staff, physiotherapists, occupational therapists, administrators, ancillary staff and, above all, patients.
When you first arrive on the wards it is a good idea to go and see the ward sister, physiotherapist, etc. and find out what their job is, what their difficulties are and how they view the patient, other groups and, most importantly, yourself.

Remember these points.
° Time—when you talk to anyone, try not to appear in a rush or they will lose concentration and not listen. A little time taken to talk to somebody properly will help enormously. One minute spent sitting down can seem like 5 minutes to the patient; 5 minutes standing up can seem like 1 minute.
° Silence—in normal social interaction we tend to avoid silences. In a conversation, as soon as one person stops talking (or even before) the other person jumps in to say his or her bit.When interviewing patients, it is often useful, if you wish to encourage the patient to talk further, to remain silent a moment longer than would be natural.An encouraging nod of the head, or an echoing of the patient’s last word or two may also encourage the patient to talk further.
° Listen—active listening to someone is not easy but is essential for good communication. Many people stop talking but not all appear to be listening. Sitting down with the patient is advantageous, both in helping you to concentrate and in transmitting to the patient that you are willing to listen.
° Smile—grumpiness or irritation is the best way to stop a patient talking. A smile will often encourage a patient to tell you problems he would not normally do. It helps everybody to relax.
° Reassurance—if you appear confident and relaxed this helps others to feel the same. Being calm without excessive body movements can help. Note how a good consultant has a reassuring word for patients and allows others in the team to feel they are (or are capable of) working effectively.As a student you are not in a position to do this, but you can contribute by playing your role efficiently and calmly.
° Humility—no one, in particular the patient, is inferior to you.


by Umaee
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