The Key to a Good Patient Presentation

When I was a 3^rd year medical student, I made my first patient presentation to my attending on my first rotation. He seemed old-as-the-hills, wise, and gruff. Trembling and with butterflies in my stomach, I was basically reciting a prayer as before a god as I read off my photocopy of the patient’s history and physical exam.

I jumped from the medical history to the HPI, to the ROS, to the physical exam, back to the HPI. With a slight tremor in my voice, I asked how I was doing. “Terrible”, boomed my attending’s voice. He mentioned something about being more organized. The rest of that session was a blur as I shrank away, red-faced, and embarrassed.

Fast forward several years. As the teaching attending now, I get to listen to student presentations. The students still fumble through their presentations. Before they even get to ask how they are doing, I tell them “Stop…. Tell me what diagnosis you think this patient has.” They sometimes tell me with the slight tremor in their voice that I had years ago. To which I reply, “Now start again… and convince me the patient actually has that diagnosis.” Without fail, the presentation improves, regardless of whether their diagnosis is actually right.

Often trainees lose sight of why they make a presentation when they focus solely on how they make the presentation. Trainees focus on the mechanics of the presentation: making sure they have enough organ systems in the ROS, mentioning allergies before medications, debating whether to put medical history before HPI, etc.

They lose sight of the key goal of a patient presentation: you are trying to convince your audience of something. What are you trying to convince your audience of? That the patient has a COPD exacerbation? That the patient needs urgent transfer? That the patient is ready for discharge? I have seen that when my students keep this goal in mind in mind, it will guide their presentation and with a little practice, the pieces will fall into place to make a cohesive story. Having a guiding light type of principle tends to focus them, organize their thoughts, and make their presentations clear for themselves and their listeners.

If you are a student looking to improve your communication skills in a clinical setting or an experienced clinician looking for resource to  teach better communication to your trainees, consider checking out my books: The Handbook of Medical Charting and A Guide to Clinical Decision Making