You’ve made it! You’ve left the lecture halls, video recordings and textbooks behind. Yet the transition to clinical rotations is one you’re likely to meet with a reasonable amount of anxiety. Here’s a guide on what to do before, during and after your first clinical encounter with a patient.
Before
The best way to approach your first patient encounter is to break it down into steps. Not only will this approach help you obtain all the information that you need in the encounter, but it will also help calm your nerves.
Introduce yourself
You might be so focused on your patient that you forget to plan the best way to introduce yourself at the start of the encounter. Be clear about your role, as it’s important for the patient to know which member of the team they’re talking to.
Establish the order of your interview
The easiest way to ensure you collect all of the patient’s information is to address the major categories of a patient presentation. This typically means determining the history of the present illness, review of symptoms, past medical history, past surgical history, home medications, allergies, social history and family history. For your initial encounters, it’s helpful to write down these categories on a sheet of paper to remind yourself what you need to ask in case nerves strike in the moment.
Practice
Medicine is a field where we ask our patients about topics that most individuals wouldn’t share with strangers, from sexual history to substance use. Ask a colleague if you can practice speaking to each other, either as yourselves or as characters. It’s important to practice physical examination maneuvers so that you feel more comfortable working with patients and asking about sensitive themes.
During
While you can’t plan everything that’s going to happen during your time with a patient, here are a few reminders to keep the interaction on track.
Remember transitional statements
The more you describe your aims and what you plan to do, the better. Patients appreciate these transitional statements to help guide the encounter.
My typical sequence is to first introduce myself and then follow with a statement such as, “I heard a bit about your story from the emergency department, but I’d like to hear in your own words what brought you to the hospital/clinic today.” Patients are asked the same questions by multiple members of the healthcare delivery team, so having some buy-in to the conversation is helpful. Prior to the start of the examination, I say something along the lines of, “Thank you for answering my questions. Now I’m going to do my physical examination. I’ll start by listening to your heart.”
Write it all down
As a medical student, I was so impressed by my residents and attendings who were able to obtain an entire history without using a pen and paper. For your first patient encounter, be realistic. Write everything down and find a system to keep your patient notes. I was fond of the Medfools handouts when I was a medical student.
Create a safe space
Before you launch into any sensitive subjects, frame that portion of the conversation by discussing confidentiality. Share with the patient that the entire medical team will be aware of the details discussed; that way, they aren’t surprised when your attending knows what they shared with you. If you can, sit down during the encounter so that the conversation is more relaxed. Allow time to simply listen to your patient—some of the most useful information is what comes when you ask, “Is there anything else that you think I should know?”
After
Following the patient encounter, you’ll have to assemble what you’ve learned and heard into a patient presentation. This presentation will require an assessment of the patient’s clinical status and plan for each active medical problem.
The most important steps following the patient encounter are keeping your patient abreast of updates, communicating the decided upon plan and assessing their level of comfort with said plan. There’s no universal right way to approach patient encounters, and each clinical encounter will help you determine your style and comfort as you engage with patients. Reflect often on your areas of improvement and in time, nervousness will be a thing of the past.
