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Pass at second attempt, Now I am back to help you - sure4
#31
I have a very short and simple question...are the results relesed like in the website or it happens that they release before...just anxious on my results..thanx a lot
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#32
ayuan
please post your email ID over here,..............i will contact you.........sure4 will contact you for sure!
Hope you don't mind

freud
for step 1 or CK same..................it is declared at 9 AM EST on Wednesday day

for CS there is schedule declared at 9 AM EST on that particular day
http://www.usmle.org/Examinations/step2/...rting.html

Good luck to all

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#33
another nice guy with help..............

http://www.usmleforum.com/showthread.php?tid=368141
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#34
novel apple's approch

http://www.usmleforum.com/showthread.php?tid=368131
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#35
thanks. wonderful.
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#36
u r welcome
luago
and good luck
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#37
hello sure4...thankyou for all ur advices..do u have any link for kaplan cases for cs..i dont have that book..plz if u can help..my email is moon2311
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#38
puchhoo........
thank you
& sorry......i don't have the link..............but will email u if i get one
good luck
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#39
One of my friend who have done kaplan classes was unable to pass CS..........SO PRACTICE IS THE KEY..........so practice practice and practice........good luck
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#40
* ReTongueass at second attempt, Now I am back to help y
#1585240
sure4 - 12/07/08 12:27

History,PE,PN,DD,Ix


Focused medical History (Look for 'Acting' Hints & Tips from the SPs)

1 Read door way information carefully
2 These are soft signs that SPs might display. Showing that that u noticed it says oceans about your observation powers ! and courteous behaviour ! I looked for these the moment I entered the room and introduced myself.
3 Yawning SP : Ask - "You look tired Mr. Smith, did you sleep well ?" This could unearth a duodenal ulcer that kept the patient awake at night ! Ofcourse other possibilities exist.
4 Shivering SP: Could mean fever or also could mean the room is too cold .right ? so first do ask the SP if the room temperature too cold for him/her. Surely shows u as very courteous and sensitive to the patient - if he / she says yes, say " Ok, I will have the nurse fix the temperature very soon". Or could it mean hypothyroidism :-)
5 Sweating SP : It is important is to remind yourself that this case could be a case of bleeding with hypotension like Bleeding varices , hematemesis, etc.
6 Be a good listener
7 Child at home “ components of physical examination may be recommended as a œdiagnostic test in the written note
8 Rectal exam, Pelvic Exam, Breast Exam and Conjunctiva exam must not be performed and can be kept in diagnostic work up
9 Patients generally refer bodily locations in lay terms
10 Patient identify the areas by pointing
11 Ask very first time a symptom appear, Patient might minimize prodromal symptoms. Always establish the last time when a patient felt in a normal state of health. Dating and chronology of illness is very important.
12 To ask depth “ Ask whether it is on surface of body or deep within?




Focused Physical Exam (indicates only pertinent positive and negative findings related to the patient™s chief complaint.)
1 Note both Positive and Negative findings in Patient™s note
2 Unless you are explicitly told not to do so as a part of the examinee instructions for the case.
3 Warm hands by rubbing together and rub diaphragm of stethoscope by ribbing with palm.
4 Take permission before uncovering the patient. The patient should always be made to feel that he is in control of his body. Keep the patient informed of what is going on as well as to ask his consent before each step.
5 You can ask the patient any additional questions that you feel may pertinent to the history, but at that time stop physical examination & re-establish eye contact.
6 Apply no more than the amount pressure that is appropriate for maneuveur
7 Consider all detectable abnormalities as a real.
8 Tell the patient that you are now going to conduct physical exam and wash your hands
9 Begin exam in logical manner from head to feet
10 Drape the patient with care and never examine a patient through clothing.
11 If you write PN during PE, consider rewashing your hands
12 Pain œ I know you are in pain, but let me help you. I™ll do this as quickly as possible. I™ll let you know exactly what I™m going to do before I do it. Assist patient when needed to move. œ I know you are in pain. This exam will help me to understand what is causing it.
13 Thoroughly examine the target area
14 In every encounter allow time for any patient question during closure.
15 Skin must be examined as you examine a region for scar, mole, psoriatic lesion, bruise etc and mention it in PN
16 Check all the orifices with a light source.
17 Pulm Exam “ Don™t percuss / auscultate over scapulae. Let the patient fully inhale / exhale before moving to next area. Check 2 levels on anterior chest, three levels posterior, one level below axillae. Chronology “ Inspection, Palpation, Percussion, Ausculation. For wheezing patient will whistle. For decreased respiratory sound patient will move the chest without really inhaling air. For increased fermitus patient will say 99 in coarse voice.
18 Abdomen “ Chronology “ Inspection, Auscultation, Percussion, Palpation. Start away from the pain and move towards it slowly. œDoes it hurt more when I press in or let go? In case of pain consider the pain on palpation as a positive sign. Don™t try to palpate the same area again.
19 Nervous system “ Try the reflex only once; if you don™t see it, it is not there
20 CVS “ For carotid bruit pt will tell Hush Hush. For Heart murmur patient will say Hush Hush.




















Patient Note
1 Negative finding are just as important as positive finding
2 Keep notes organized and present the information on logical order.
3 Present a reasonable list of diagnoses based on the history and physical examination; workup should be designated to reduce D/D
4 CC- one sentence description with age & sex
5 HPI “ L I Q O R A A A
6 PMH “ P A M H U G S, Okay Mr. .., the way medicine works, there could be some clues hidden in a few personal questions I need to ask you “ Is that okay with you? F O S S œIs there anything else you want to tell me?
7 S O D A S T I M E, Smoking, Occupation, Diet, Alcohole-cage, Travel, Illicit drug, Marriage, Exercise
8 D I A B E T I C “ Duration of disease, Insulin, A1c-glucose, Blurred vision(retinopathy), Extremity (Foot ulcer, infection), Tingling/numbness (neuropathy) Infection (pulmonary/urinary) Cardiac risk factors (CHO, HTN, Heart Diseae)
9 œI shall now perform a quick general examination and then look at your -_____ is that fine?
10 List general appearance & vital signs with are they normal / abnormal mentioning
11 HEENT Exam -
a. Head “ NC / AT “ Normocephalic, Atraumatic
b. Eyes “ EOM intact,PERRLA, fundoscopy/papilledema “ w/i Normal limit
c. Ears- Canals w/o abnormalities, TM clear
d. Nose- Turbinates not congested
e. Throat “ No tonsillar enlargement, erythema or exudates
f. Mouth “ Dentition “ good, - lesions, - vesicles, -oral thrush
g. Neck “ Supple, - thyroid enlargement, - cervical lymph nodes
12 Neurological Exam-
a. Mental status “ AAOX3, good concentration
b. Cranial nerves “ II-VII, IX-XII intact
c. Motor “ Strength 5 of 5 all muscle groups
d. DTR: 2+ intact
e. Sensation: intact to sharp and dull
f. Cerebellar “ Romberg negative, finger to nose intact
g. Plantar reflex “ Normal
h. Kernig , Brudziski “ Negative

13 Respiratory Exam-
a. R & L “ clear to auscultation
b. (-) cynosis, (-) clubbing
c. (-) tenderness to palpation
d. (-) Dullness on percussion
e. (-) Rales, (-)Wheezes, (-) Rhonchi, (-) Rub in any lung field
f. TVF WNL
g. CVS - BP---, HR----, Pulses 2+ BL
h. PMI non displaced
i. (-) palpable heaves, S1/S2 regular rhythm, (-) murmur
j. (-) rubs, (-) gallops, (-) JVD, (-) pedal edema
14 CVS
a. BP---, HR----, Pulses 2+ BL
b. PMI nondisplaced
c. (-) palpable heaves, S1/S2 regular rhythm, (-) murmur
d. (-) rubs, (-) gallops, (-) JVD, (-) pedal edema

15 Abdomen
a. (-) surgical scar or abnormalities on inspection
b. + BS
c. Percussion “ tympanic in all 4Qs, Liver normal in size
d. (-) palpable mass, soft, non tender, non distended to palpation
e. (-) CVAT, (-) HSM
16 Lumbosacral region
a. (-) obvious deformity / trauma
b. (-) tenderness at spinous process / paraspinal region
c. ROM Normal
d. Normal gait
e. Reflexes “ 2+ patellar, Achilles
f. Sensations intact (sharp / dull)
g. Motor strength 5/5 both UE / LE
17 Psychiatric Mental status Exam
a. Patient “ well groomed
b. AAOX3
c. Speed is fluid and goal oriented
d. Recent and motor memory is intact
e. Attention & Concentration are unimpaired by serial sevens.
f. Mood “ Euthymic, Affect is consistent with mood
g. No abnormal perceptions as Hallucination, Delusions, Paranoias
h. Patient denies having suicidal/homicidal ideation / intent
i. Judgment / insight are intact

D/D
1 D/D should derive from History and PE
2 Don™t include irrelevant Diagnosis just to fill up the space
3 Make sure your diagnosis are specific “ Don™t write pregnancy but write Intrauterine pregnancy or Ectopic pregnancy
4 Try to link a diagnosis linked with another “ AIDS with pulmonary tuberculosis
5 Only include realistic possibilities

Diagnostic work ups
1 Always write first line, specific, simple, non invasive and less expensive tests, group similar testes as one and in orderly fashion
2 Don™t order treatment, hospitalization, referrals or consultations

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* ReTongueass at second attempt, Now I am back to help y
#1585241
sure4 - 12/07/08 12:28

THERE ARE THREE COMPONENTS OF CS AND MOST IMP IS CIS FOLLOWED BY ICE AND LAST IS SEP

CIS
1 Give clear instructions, explain what you are doing each step
2 Assure the patient that each maneuver is medically important
3 Summaries your findings from the history and confirm their accuracy with the Patient
4 Answer any questions patient may have
5 Speak clearly, slowly, carefully and rephrase as and when needed

Inter Personal Skill
1 Interviewing and collecting information
2 Counseling and delivering information
3 Establishing rapport
4 Maintaining personal manner


Conduction interview
Entering the room
-Knock the door
-Wait for an instant
-Open door just enough to ask the patient™s permission to enter
-Never refer to any patient by first name only
-More light hearted phrases are best avoided
-When you refer to information they have provided, patient knows that you have
taken interest in their concern, and this enables rapport to be rapidly established
-Before you begin the medical interview, apply the drape to cover the patient™s lower limbs
Interviewing and collection information
-Use clearly worded questions, use as few words as needed to express an idea
-Speak slowly
-If medical terminology must be used, explain the term immediately in lay language before the patient has to ask
-Do not use slang language
-Ask for clarification as and when needed by œWhat do you mean by that?

Clarification and other questioning techniques
-Clarification is also a way of verifying with the patient
-Paraphrase throughout interview process “ i.e. paraphrase chief complain
-Phrased in a way that encourages a longer, more detailed response “ Can you describe that (open ended question) then ask more specific questions
-Its good idea to quickly reflect the main points to the patients
-Use affirmative mode rather than the negative
-Ask questions in such a way that the patient feels at ease in confiding what can be something is embarrassing admissions
-Ask only one question at a time

Don™t interrupt
-Unless absolutely necessary
-If patient start crying “ sit down for a while, wait for 3-4 seconds “ hold his / her shoulder by your hand for a second “ express empathy by œ This must have been a very difficult time for you. Mr/Mz , would you be willing to share with me what happened this time? And also offer tissue paper (never lose a sight of the human connection)
-If patient starts talking irrelevantly “ œExcuse me for interrupting, Mr./Mz. I know these concerns have really been troubling you. However, right now I want to focus completely on you.

Transition
-Before the Past Medical History “ œOkay, Mr/Mz, now I am going to ask you some questions about your health in general.
-Before sexual History “ œAlright, now I need to ask you some questions about your sexual history so that I can understand your health in general. Whatever you tell me will be kept confidential. Try to be as honest as possible
-Before social history “ œThank you, Now let me ask you about your work, family and social life.
-Before asking questions about smoking, alcohol, and recreational drug use. œOkay, now I need to get some information about your life style.
-Before the family history œ Now let™s talk about your family™s health.
-Before the physical examination “ œAll right, thanks for answering all these questions. Now I need to examine you, so I™ll just wash my hands. Excuse me Okay, Mr / Mz. Let™s begin by
-During physical examination, before any maneuver.
-Before closing “ œThank you for letting me examine you, Mr. / Mz, now I would like to now sit down with you and give me your impression. First of all let me summarize.

Summary
-Briefly summarize what you have heard in the history and found in physical exam.
-Briefly explain u™r most likely differential diagnosis in lay & then medical terms
-Explain the testing you need to do in order to arrive at a conclusion.
-Avoid offering pain meds during encounter.
-Avoid alarming the patient; be careful and sensitive in the way you explain the possible diagnosis. However, you must let the patient know what you are considering. Say that you œpromise to consider such and such, if it is something frightening like a tumor.
-Summarize history taking finding immediately after history taking and again after physical examination. Summary should include only the points relevant to the patient™s chief complain. Ask is there anything else you would like to tell me about?

Closing and delivering information
-As soon as we know precisely what you have, we will sit down to gather and go over the various treatment options. So, first, let us get that tests started, and then we shall go from there. Tell the testes and D/D. Mr after we get the results of those testes, we will meet again and at that time I will be in better position to offer you exact diagnosis and various available treatment options. Does this sound OK?
-œHave you understood everything we discussed today? œDo you have any other questions? ..thank you Mr. ., I shall leave my contact number with my nurse “ feel free to contact me anytime if you have questions.
Do you have any questions or concerns?
-Reserve management discussions œuntil we are sure what the problem is
-Never deny the patient™s beliefs
-Ask if the patient has any questions. Answer each question clearly with reassurance.
-Reassure the patient that you will do everything you can to help.
-Shake patient™s hand-if offered “ and say œI shall follow up with you as soon as I receive the results. Its nice working with you. I will do my best to make you feel better. Thanks for your co-operation. Have a good day, Bye for now, take care
-Leave the room.
CS Strategy
1 Wash the hands in front of patient œArrite Mr, Excuse me for a moment here to wash my hands (smile)
2 Sit down facing the patient
3 Be aware of your facial expression
4 Lean towards patient
5 Nod your head periodically
6 Keep upper limbs unfolded an comfortable
7 Consult the medical record
8 Vary pattern of gaze without starring
9 Move from time to time, rather then sitting stiffly.
10 Ask questions in neutral & non judgmental way



Rapport & Non verbal communication
1 Show a sense of genuine concern and care, and attitude of composure, calm & clarity
2 Slow down your pacing & lower your volume
3 Stand at 45 degree angle, slightly off the patient when needed
4 Never stand behind the patient during the history or closure.
5 Look the patient comfortably in the eyes.
6 Focus attention solely on patient, not on yourself as a performer.
7 Listen to the patient
8 Carefully observe and ask questions accordingly “ SP will not volunteer the very piece of information
9 Support the patient physically by extending leg rest or by helping him / her to turn over.
10 Acknowledge pain “ œYou seem to be experiencing a lot of pain right now. Is there any thing I can do to help you feel more comfortable?
11 Keep an eye on patient “ Observe for any sign of discomfort, change of mood and comment on these changes.














COMMUNICATION SKILLS CHECK LIST
1 Appear professionally dressed / groomed / hygiened.
2 Knock the door before entering. Wait for a while and then slightly open the door and call the patient by last name. i.e. Mr. Smith? Normally patient responds (if doesn™t respond to name think about change in mental status)
3 Introduce yourself by name “ Mr / Mz.?, Good Morning, Let me introduce myself. My name is Dr. Sapariya. It™s nice to meet you. I™m a doctor here in the hospital. Let me make a you a bit more comfortable by covering you. So, Mr. What brings you in today? Pt will tell CC. œOh! I am sorry to hear that. I shall my best to help you and make you more comfortable. I would like to ask you some questions and do a physical exam.
4 Make comfortable eye contact. “ look directly and easily in patient™s eyes (which demonstrates confidence and reinforces a sense of trust & credibility)
5 Focused attention and concentration on patient
6 Convey a respectful and nonjudgmental attitude “ body language “ openness & receptivity. Non judgmental facial expression “ don™t raise eye brows or frown. It is not necessary to respond after each & every answer. Avoid phrases or words like œGood. A simple œThank you or œOkay is often sufficient. Reserve all the patient education for very end of encounter.
7 Use drape immediately after introduction “ makes the patient feel less vulnerable & show greater respect for the patient™s privacy. œLet me make you more comfortable by covering you. Let the patient know that you are going to untie the gown or move the drape. As little of the body should be exposed as necessary. Lower the gown to examine upper chest and shoulder. Raise it when to examine legs. Raise it with draping of legs when you need to examine abdomen. Replace the drape without delay when u have done specific region examination. It is best to sit down on the stool, relax and keep the clipboard on your lap.
8 Use transitional phrases & references.
9 Express Empathy (reflected patient™s feelings) and make appropriate reassurance. œYou look you are in pain. Is there anything I can do to help you feel more comfortable right now? Crying “ Pause silence for several seconds. Offer the tissue box. Hold his / her shoulder gently for couple of seconds. œThis must have been a difficult time for you. Can you tell me about it? For patient™s misbelieves “ œ That is one possibility. I would like to check some other possibilities. Suggestions “ œIt seems like you may be.. Challenging question “ Cancer? œ Mr..I understand how scary this can be, but I need to be very systematic and careful. So let us take one step at a time. First I need to have you take some blood and urine tests & some x-rays. Then after I study the result with your examination findings, I will be able to give you a definitive diagnosis and explain your options for treatment. You and I will sit down at that time & go over everything in detail, okay? Appropriately reassure patient that œThey are in a safe place with excellent medical staff.
10 Give patient time to think and answer without interrupting. Patient should not feel rushed. Patient™s answers should not be cut off. Quietly wait for the patient to complete each answer. Don™t fill in words for the patient; the answer should be in his or her own words.
11 Ask 3-4 open ended questions during entire history
12 Se non leading questions.
13 Ask one question at a time then pause and wait for an answer before going on to the next question.
14 Use lay language or explained medical terms. If you accidentally use a technical or medical term, immediately explain what it means in simple, straightforward language, BEFORE PATIENTS ASK TO DO SO.
15 Effectively listen and paraphrase information given by patient throughout the encounter; patient knows that you are listening and getting information correct. Paraphrasing gives the patient the chance to correct any wrong information.
16 Remain connected and purposeful during physical examination.
17 Summarize significant information during closure, and discuss diagnostic tests. By the end of encounter, the patient should know what to do next. Technical terminology should not be used in specifying lab work. Psychiatric cases “ knowing about support available in the hospital or community, such as counseling or peer support groups. If patient can™t afford management “ state that social service office can work with patient to identify financial of other resources available in the community
18 Place patient at ease and communicate information without alarming patient. Talk with the patient during the physical examination to reduce patient anxiety and increase co-operation. Tell the patient what you are going to do and possibly why? (With reasoning). If medical term is needed to be used “ immediately explain the nature of the disease to the patient in simple, straight forward language, before patient asks to do so
19 Ask the patient if he had any question, and then answer it appropriately, briefly, in a clear, plain and reassuring manner.




SPOKEN ENGLISH PROFICIENCY

1 Speak more slowly then casual conversation
2 Questions and sentences should be relatively short and to the point
3 Phrasing should not require any interpretation on the part of patient or judgmental on the part of physician.
4 Word should be short and non technical.
5 Use recovery strategy.
6 Maintain a professional yet friendly demeanor.

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* ReTongueass at second attempt, Now I am back to help y
#1585242
sure4 - 12/07/08 12:30

NOW WHAT WILL U DO FOR CHALLENGING PATIENTS?


CHALLENGING PATIENT
Strategy - Be honest & diplomatic.
Restate the issue back.
Don™t give the patient final diagnosis, but tell the initial impression & about the workup.
Don™t give false assurance.
If you don™t know the answer to the Q just tell him so and assure him that you will find out the answer and let him know.

1 Anxious patient “ Encourage the patient to talk
2 Pain “ Patient visibly in pain “ œ Mr. .. is there anything I can do to make you more comfortable?
3 Light sensitivity “ offer to pull down the shades or dim lights
4 Patient in pain and asking for pain medication “ œ Mr. I will get you something to help with your pain. First, I need to ask you some questions and run a few tests to get a better idea of what is causing your pain before we mask your symptoms. I will be as quick and gentle as possible.
5 Un co-operative patient for physical examination “ First do as much of the exam as you can with the patient in his or her preferred position. Then for remaining exam “ explain how important it is to do the exam correctly and ask him to move. Acknowledge the patient™s feeling and / or frustration. Reassure him that you are there to give him your undivided attention and will do everything possible to help him feel better. Let™s now begin discussing more about your discomfort. Offer him help to move. If the patient still refuses.simply move on and document in your note.
6 Doctor, am I going to die? “ Balance your answer so they neither alarm the patient nor give false reassurance. œYour condition may be serious, but until I get more of the tests back, I can™t really tell you more than that. You should also know that we have an excellent team of doctors & nurses to help you through this. OR œ I understand your concern. There is no need to be unnecessarily concerned at this time. The most important thing is that you are here now and we will do everything we can to help you.
7 What kind of test is this? Will it hurt me? - Explain before asked if possible. œIt might hurt for just a moment or two. I™ll warn you right before it might hurt. Please bear with me; this will assist me in discovering what is wrong and how I can best help you.
8 Angry patient “ Stay calm. Don™t be scared. Let him express his feelings. Ask about the reason for his anger. œMr. I can see you are angry. Can I help?. œI know you are depressed about your symptoms and I want to help you feel better. œ Here is a box of tissues. Are you able to tell me why you are crying?
9 Crying patient. Silence for 3-4 seconds, and perhaps an empathic touch. Offer a tissue. Wait for 2 more seconds of silence. œWill you share with me what happened or what you are feeling? I Shall need to ask some questions to try and help you
10 Verbose patient. Redirect him. At the right moment, gently interrupt and guide the patient back to discussion of symptoms. USE CLOSE ENDED QUESTIONS TO DO SO. œI understand that_________________ is important to you, but I want to get back to your problem. Can you tell me mre about ___________, please? Thank you .
11 Mother took appointment for child (unaware for condition) - œ Why is your mother concerned? œ How can I help you?. œ In order to help you, I need you to tell me more about your problem. If you give me more detail, I™ll be able to determine what brings you here, and then I can help you to feel better. Please be assure that what ever you tell over will be kept confidential.
12 Don™t want international doctor œ I can understand your concern. But let me inform you that I am a US-licensed physician., fully qualified to manage your care, and I can assure you that I am here to help you today. If you still fell this way at the end of our meeting, I will make a note so that you can see someone else next time. Let us get started.
13 HIV “ œ It appears if you may have an infection that is causing your symptoms. We need to run some additional tests to determine if this is an infection and what the extent it might be. We can discuss the results when I receive them.
14 Cancer œI can imagine how frightening this must be, Mr. .. There are many things other than cancer that can cause you to feel this way. So let me do an exam and order some testes and then we can talk about what you might have. I™ll keep in mind, though, your concern about your cancer.
15 Poor vision & hearing- tell her where you are sitting and help her with anything she needs or maneuvers she may need to perform. Sit close to him and speak into best ear if one is better. Face the patient directly to allow him to read lips.
16 I don™t have time. Just give me antibiotics. Explain that routine procedures are necessary. Be as specific as possible: œAntibiotics treat infections and are not always indicated for the type of symptoms you have. I will need a few minutes to ask you a few questions and perform a brief examination to make sure we get you the correct treatment. After this examination, we can discuss whether or not antibiotics will help you to feel better.
17 Domestic abuse SAFE . Safety- Are you concerned for your / your kids safety?. Afraid - Are you afraid of? For what? Friends / Family Do you have support of your friends and family? Emergency plan “ Do you have any emergency plan to implement if situation arises?
18 Depressed non responding patient “ I know this is very tough time in your life, but I assure you that we can deal with this much better to gather. I really want to understand your problem and help you as a friend and a physician. You said you were perfectly happy and normal before months ago “ could you try and tell me what exactly happened months ago that started this?
19 I want to die doctor “ I know this is very tough time in your life, but I also know that running away from problems is not the answer. I really want to understand your problem and help you get your strength back, because I know it is possible. We can deal with this to gather.
20 Don™t have money “ Not having enough money doesn™t mean you can™t get treatment. We will refer you to a social worker who can help you find resources.
21 Pt doesn™t know the names of his medication or is taking medications whose names you don™t recognize. “ Ask the patient if he has a prescription or a written list of medication he is currently taking.
22 Will I die ?
SPs are amazing actors - and they are trained to asked amazing questions ! Their idea is to stump you - but your goal is to stump them and leave them without any more questions ! The idea is 'never to commit anything' - and why is that skill important ? So that you dont give any false hopes to your patients in real life and get sued and screwed !

Mrs. Ray, it must be very tough for you, but we must wait for all the Ix results to comment on that. Lets hope for the best (Smile), I will keep you informed.
23 I am in pain ! Please give me a pain killer !
I know it is not easy to bear the pain, but without unless we know what we are dealing with, it will be tough to decide the right pain-killer. As soon as we are done with a quick examination, I will have my nurse treat your pain. Is that fine Mr. Harrison?
24 Doctor, do you think I have a fracture ??
It is a possibility, but we must wait for your X-ray to arrive.
25 Is this cancer !!!!!!!!
Mrs. Hicks, I understand your apprehension, but we need to wait for investigations. I will keep you informed.
26 Beware !! There is another kind of questions they would love to ask you and eat your time - medical term clarifications questions, like "Did you say arrythmia ? Is that a new drug ?".
Sure - it sounds ultra-cool to use those sophisticated medical terms, but these SPs are testing your communications skills towards a layman - so let us stick to layman terms and not give them a chance to ask for clarifications !

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* ReTongueass at second attempt, Now I am back to help y
#1585244
sure4 - 12/07/08 12:31

OK NOW HOW ONE SHOULD COUNSELL THE PATIENT?

Counseling

Awrite ! All our lives, haven't we simply loved to give advice to anyone and whenever we get a chance (coz deep inside makes you feel kinda superior and good about yourself ;-) ) It ain't nothing different when it comes to 'counseling' your SP on the CS exam !

Difference is - you got to be fast and to the point or concise. Because after you leave the room and the SP starts marking his checklist to grade you - the very fact that you addressed the issues worth counseling will make him/her put a tick-mark next to counseling. No matter how much time you spend 'counseling' you still gonna get the same tick-mark. So decide if you will spend 1 minute and be done or spend 5 lengthy minutes !

Smoking : "Mrs. Ray, as a concerned physician, I must ask if you are aware of the bad-effects of smoking on your health... Have you ever tried quitting ? coz' it will save you a lot of health and money in the long run. I understand that old habits die hard and all people experience difficulty in giving it up due to stressful symptoms. But you can use Nicotine patches or Gum to help reduce those withdrawal symptoms and we even have a professional team to help you deal with it better. Feel free to contact me anytime if you decide to quit. "

Alcoholism / Alcoholic Patients:
"As a concerned physician, Mrs. Dodge, I must caution you about the ill-effects of alcohol consumption. Alcohol has tons of calories but lacks nutrients. Besides altering judgement, excess consumption raises your risk of high blood pressure, strokes, vehicular accidents, and is known to cause Liver Cirrhosis, Inflammation of the pancreas, brain and heart damage along with birth defects if consumed during pregnancy.

- Limit intake to one drink per day ( for women) or two per day (for men).
- Eating food while drinking will slow alcohol absorption.
- Avoid drinking before or when driving, or whenever it puts you or others at risk.

We have a professional support group who would be eager to help you overcome your habit, if you wish to give up but find it tough to do it by yourself."


Diabetes: After you are done with explaining investigations - "So Mr. Jim - we will begin your treatment once I have evaluated your lab results. I want you to know that besides drugs, there are other simple but important measures to keep yourself healthy and reduce complications. 1. Follow regular exercise and diet instructions that will be provided to you 2. Diabetic patients are vulnerable to injury-induced ulcers on the foot, so make a habit of using soft footwear whenever you walk - indoors or outdoors. 3. Be regular in blood-sugar monitoring so that dose adjustments can be done on time. Now was that too bad ?" (smile)

Hypertension Counseling: "Mr. Demiris, for a majority of patients, we cannot detect a cause for High Blood Pressure and is well controlled with exercise, diet changes and drugs, if needed. However, there may be some patients with treatable causes - we shall do a few tests soon to see if we can detect those in you."

Enuresis (Bed wetting) Counseling : "Mrs. Cole, kids with bedwetting usually undergo natural healing with age, but this problem needs tenderness. Punishing your child could worsen it - a much better technique would be to rather reinforce positive behaviour by praising and rewarding him if he stays dry while sleeping. I would advise you to monitor your child's drinking habits before going to bed and encourage the child to go to bathroom before going to bed. We also need to do some tests to rule out other conditions."

HIV Counseling:"The biggest danger in HIV may not be the HIV itself - rather other diseases that can occur more easily due to reduced body resistance. This means that your body must be fortified in advance against such disease with vaccines. Secondly, even the mildest suspicion of an infection must be tackled aggresively. Thus, periodic examinations and followups are important. We have a professional support group here which will help you with strengthening you emotionally and tackle other social issues with you."

Safe-Sex Counseling points:
1. Multiple sexual partners and unprotected sex put you at risk of Sexually transmitted diseases like HIV, gonorrohea and increase the risk of Cervical Cancer, unwanted pregnancies and complications from abortions.
2. Don't have more than one sex partner at a time. The safest sex is with one partner who has sex only with you.
3. Watch for symptoms of STDs, such as unusual discharge, sores, redness, or growths in your and your partner's genital area, or pain while urinating.
4. Use contraceptive methods to protect yourself - u can consult your family physician for specific methods that will work best for you.
5. Add counseling about PAP smear depending on the Patients age !
6. Be responsible - Avoid sexual contact if u have symptoms of an infection. If you or your partner has herpes, avoid sexual contact when a blister is present and use condoms at all other times.

Lab-Result (Trichomonas): Lets go over some relevant points in this case -
1. Both the SP and her partner needs treatment.
2. While on Metronidazole therapy - alcohol is to be avoided, since that will cause nausea and vomitting (Disulfiram like reaction)
3. Abstinence from sexual intercourse until therapy is complete 4. If lady has multiple sexual partners - counsel on protection, risk of other STDs like HIV & risk of cervical cancer (need for PAP smears).
5. Ask her if she has had a pregnancy test recently and when - if not done, ask her to consider having that done. (and mention that on your PN as an Investigation)
Counseling for Heel Pain:

1. Use soft-heeled or soft-padded footware
2. Refrain from long standing positions or long walking activities
3. Do see us again if the prescribed pain medications do not work

Counseling a Non-Compliant Seizure Patient who wants to drive:

1. Ask him what he knows about his disease and how often does he get seizures
2. When did he last have a seizure
3. Importance of compliance for seizure control ...
4. Explain that most states in USA allow issuing non-commercial licenses to seizure patients based on the length of the "SFI" = Seizure Free Interval ..and can range from 3 to 12 months..whereas for commercial driving license, 10 years or so are required and that too while NOT taking anti-epilepsy drugs..
5. Tell him why driving is dangerous not only to him but also to others on the road in event of a seizure
Safe Sex Counseling:

1. Multiple sexual partners and unprotected sex put you at risk of Sexually transmitted diseases like HIV, gonorrohea and increase the risk of Cervical Cancer, unwanted pregnancies and complications from abortions.
2. Don't have more than one sex partner at a time. The safest sex is with one partner who has sex only with you.
3. Watch for symptoms of STDs, such as unusual discharge, sores, redness, or growths in your and your partner's genital area, or pain while urinating.
4. Use contraceptive methods to protect yourself - u can consult your family physician for specific methods that will work best for you.
5. Add counseling about PAP smear depending on the Patients age !
6. Be responsible - Avoid sexual contact if u have symptoms of an infection. If you or your partner has herpes, avoid sexual contact when a blister is present and use condoms at all other times.

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