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* Q's for the Patient encounter
 #850203  
  karuni - 04/14/18 10:57
 
  1-if the SP forgets what i asked during the patient encounter, yet i have written it both on the blue sheet and the actual patient note-will i get credit for something that the Standardized Patient just may have forgotten because they have had previous doctors interviewing them?

2-is it okay to counsel a patient during the HPI so that i don't forget to counsel them in the closure part? let's say, they smoke, just say it in a kind non judgmental manner during the history taking and then if i have extra time during the summary part just repeat it to emphasize my concern for the patient's well being? or is it best to just keep the counseling for the closure?

3-is it advisable to keep asking questions even while washing my hands or should i use that brief 10 seconds to think of my physical or if i obviously recall anything i may have missed while taking the HPI-then of course ask it-any thoughts on this?

4-if i have a patient with chronic bronchitis but i don't hear the typical lung sounds-the rhonchi, congestion, what do i write in the note? is it going to be the expected rhonchi or just clear lungs if i didn't hear anything?

thanks for answering these few vague areas for me!
 
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* Re:Q's for the Patient encounter
#3365223
  mtreddy - 04/15/18 14:19
 
  1) assume that they dont forget, dont lie. They have quality control process, and they videotape everything. mostly they dont forget.
2) you can counsel the patient anytime you want, but remember it is 15min encounter, so each case has goal, one tests history, one tests your empathy one tests your physical exam style etc. you will know which way the case is heading, then do other things quickly and start counseling.
the first priority should be gather information, then discuss the plan and smoking is among the planned part, if you go off track you have a great chance of messing up the whole case. Every encounter has an agenda, for example discuss the results, followup the appointment, etc. so you should be able to prioritize your encounter. same with acute cases, focus on what the patient is for in for today.
3) depends on the case, if you are running out of time, then ask questions, if you have plenty of time you can wash your hands or plan to do next up to you.
4) write what you hear or see, dont write assumed stuff. they just want to see if you will be focusing on the right system and are you looking for things you expect on PE, for example you will say to the patient, while hearing that you didn't hear any ronchi, write in your sheet specifically that no rhonchi are heard instead of writing lungs are clear. the examiner will know that from history you are expecting to hear ronchi.
 
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* Re:Q's for the Patient encounter
#3365224
  mtreddy - 04/15/18 14:22
 
  if the patient says he has no sexual partner, etc or you are thinking it is related to smkoing etc and the patinet says he is non smoker, no sexual activity etc, do not probe too muc. it emans they are not tutored to say thse things.  
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