Posted in Education, medical school, news, osteopathic school, students

Didn’t Match Into Residency? Your Next Steps……

“Match Week” in March of every year is like a medical/osteopathic school lottery. Thousands of students hope to get accepted into a residency and if they don’t, they use this week to apply again or “scramble” into open spots that might not have been filled.

Interview Tips for Residency Programs

Many of these applicants have fantastic CV’s or resumes, but might not have matched because they applied to programs who were highly competitive, or chose a specialty that did not have enough spots (too much demand and not enough supply).

So many other students may find themselves in the Spring without an internship or residency, feeling lost and scared about what the future may bring. If you’re one of them, realize you have options. Here are your next steps….

Keep searching for new and open spots!!!

Sites such as the NRMP and Resident Swap post the latest spots that open. Residency spots can be open post-match for any of the following reasons:

  • Some programs still have spots that did not fill
  • Some students may have extenuating circumstances that caused them to abandon a position they received during match
  • Some are new programs who just received accreditation
Image from Residency Swap

Check for openings daily!!!!

Boost your resume

While you are searching and waiting for new spots to become available you can spend the time you have doing the following:

  • Edit and improve your personal statement, MSPE characteristics, CV, etc.
  • Do research – many projects can be accomplished in a short amount of time and very meaningful
  • Do community service – again there are multiple meaningful projects that can be done that don’t require huge time commitments
  • If you had low board scores, consider retaking one of them

Consider taking Step III or Level III of your boards

Many residencies might not have chosen you because they thought you would score low on the boards. If you need to reapply next year and already have a “Pass” for your third set of boards, that issue becomes a non-issue and you become a highly competitive applicant. This may not be an option for all students, but is worth looking into.

In short, you are not alone. Hundreds of students don’t match and multiple programs fail to fill each year. And as new residencies are born each year, their timeline on accreditation or opening may differ from the rest allowing you the opportunity to apply and secure a spot in April, May and June. Don’t give up hope! You graduated medical/osteopathic school. Now let’s get you a job!!!

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in college, Education, Graduation, Health, medical school, school

To the Class of 2020: Dear Graduates…..

This year many of you have lost a moment you have spent years fighting for.  Your graduation was a rite of passage, a ceremony in which those who saw you sacrifice, toil and triumph could witness and share.  The coronavirus epidemic and resulting closures robbed you and your loved ones of this opportunity, but it couldn’t rob you of this….

Your mark in this world.

You have succeeded honorably despite multiple obstacles and reached your goal during a time when life was very uncertain.

Those of Generation Y and Z have witnessed some of the most tumultuous times, and this pandemic adds to the rocky start to many of your careers.

We older individuals might have had difficult paths as well but we had a much clearer picture of our future, of that finish line which helped guide our path.

You all had to, in the fog, reach this point and the fact that you chose to keep fighting and working at it defines the new generation of Americans.

fog

Our future may seem uncertain during this time of pandemic and economic hardship, but one thing that is certain is you all give us hope.

Our country will be rebuilt and thrive because the next generation of hardworking Americans is YOU.  You who wouldn’t falter after 9/11 or the Great Recession, or social media invading every part of your life. You defied odds and proved that a job, or money or career did not need to be dangled in front of you to complete your studies and finish your schooling.

You got the job done! And I, who have been through multiple graduations – high school, college, and medical school, am saddened that you can’t be on that stage, applauded for your perseverance, ambition and passion.  But realize, no ceremony can begin to describe the pride your friends, families, teachers, mentors and fellow Americans have for you.

You are loved, revered, and honored, and we are so excited and grateful that our future will be driven and strengthened by you and your classmates!

Congratulations Class of 2020!!!

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, iHeart Radio and Board Certified Family Physician

 

Posted in coronavirus, Covid-19, Health, medical school, news

“Why Aren’t We Learning and Helping?” Medical Students Eager to Get Back to Patients

Although some schools have allowed their students to graduate and start residency early, many have shuttered clinical rotations and hands-on learning to their students.

“Shutdown” orders that mandated schools go online, included the American Association of Medical Colleges (AAMC) recommendation in March to suspend “direct patient contact” by students.

However, on April 14th, they loosened their guidance to allow the Deans of each school to, at their discretion, allow student participation and learning if the latter were willing and trained on PPE (personal protective equipment) use.

Procedures such as intubation and central line placement are sometimes far and few between for medical students. But tragically, during the SARS-CoV-2 pandemic, hospitals are exhaustively doing these procedures multiple times a day.  For a medical student, it’s an ideal time for hands-on experience.

A third year medical student, who will remain anonymous, described his situation as a “lost opportunity.”  He states, “We’re in the biggest healthcare crisis in recent history and we students aren’t allowed to learn? What do we tell our kids who think we trained during the COVID pandemic??? ‘We sat home and watched it on TV???’

Another student found frustration with their tuition status, “We’re paying our medical school thousands of dollars each month to sit home and study on our own.  Refund our money for the weeks of learning lost!!”

Medical institutions have no easy task, balancing student safety and patient safety while at the same time ensuring an adequate education. However, if appropriately adhering to AAMC guidelines, medical students can get much needed hand’s on experience, and hospital teams can get some badly needed extra pairs of hands.

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

 

 

Posted in COMLEX PE, Health, medical school, Step 2 CS

How To Prep for Your Comlex PE/Step 2 CS

Image above from CollegiateParent

The PE/CS are practical tests, examining one’s skill with a patient, and must be passed in order to graduate medical school and enter residency.  For some students, they find the test of their hands-on skills easy.  For others, stage fright can kick in and they worry they’ll forget everything they have learned.

Relax, review and rise to the occasion!!  And if in doubt….the following tips may help:

HUMANISM/CIS

  • Greet the patient and thank them for waiting
  • Make them feel more comfortable if they are in distress
  • Respect their privacy when it comes to gowning and draping
  • Maintain good eye contact and reflectively listen
  • Allow the patient adequate speaking time to answer your questions, (i.e. no interrupting or rapid fire questioning)
  • “Intervene” by offering them assistance when they admit to having a daily habit that could contribute to a health condition (i.e. smoking, alcohol use, poor diet)
  • Ensure the patient understands the assessment or reasons for your line of questioning
  • Appear confident when you explain the assessment and plan
  • Suggest something to address the pain or distress of the patient
  • Avoid rattling on and remember closing the encounter confidently and friendly.
  • Suggest modifications that can help them at work or home if their complaints impede their job or home life.

humanism book cover final               CIS book cover

Humanism Prep Guide For the Boards
CIS Skills Prep Guide For The Boards

DATA GATHERING

  • Remember to address other body systems that could be contributing to the chief complaint (i.e. a left shoulder pain complaint may also need questioning regarding the heart in addition to musculoskeletal symptoms)
  • Ask associated symptoms or pertinent positives/negatives (i.e. in a patient presenting with back pain, inquiring about lower extremity numbness and tingling, incontinence, hematuria, etc.)
  • Address medical symptoms that may stem from a habit they have (i.e. urethral discharge if they partake in unprotected sex)
  • Address medical symptoms from a medication they may take excessively (i.e. abdominal pain or blood in the stool of a patient who takes NSAIDS often)
  • Examine the appropriate body parts that could be contributing to the illness, (i.e. thyroid and carotids in a patient presenting with dizziness)
  • Ask “why” when they take excessive medication – they may be self treating another medical condition
  • Ask “why” they come in for a physical (family member may have been worried about their memory, eating habits, etc.)

Data Gathering Prep Guide For The Boards

Data Gathering Prep Guide For The Boards

SOAP note

  • Complete all four sections (S O A P) consistently in each case
  • Address the chief complaint in all four sections (i.e. if one presents with back pain, did the note address the subjective complaints, an exam of the back, differentials of what the back pain could be, and testing/OMM in the plan that addressed the back pain?)
  • Include associated symptoms (i.e. in a patient presenting with a headache, were they negative for photophobia and neck stiffness, etc.)
  • Document appropriate history and physical
  • With the physical make sure 5-6 categories were documented (i.e. Vitals, General, Cardiac, Pulmonary, and then one or two more depending on their chief compliant – if back pain also include MSK and Neuro)
  • List the differentials that the presenting complaint could be (i.e. a patient presenting with fatigue may have depression, anemia, sleep apnea, hypothyroidism, antihistamine overuse)
  • Include testing, medications, work/home modifications, OMM (DO students), and follow up in the plan.

OMM (for DO Students)

  • Ask permission prior to performing the OMM
  • Explain what OMM is and why you are choosing to perform it
  • Do not appear “rough” in technique
  • After performing the OMM, ask how the patient felt and its effect on symptomatology

 

Most students who study and practice, PASS their PE/CS and match, going on to residency.  If you need help, reach out to your school, students who passed, or even me for tips.  You got this!!

 

ultimate book cover final

Great Gift!!!

The Ultimate Medical Student HandBook

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in COMLEX 2 PE, Education, Health, medical school, news

COMLEX 2 PE Failures: Your Questions Answered

This is Part II in a series in which we put your mind at ease after you learn you failed one of the most important tests in your training.  We know it’s not easy and lots of emotions are stirring, but since you will need to retake the exam, let’s dissect the most common questions so we can get you ready for the next one.

Why did I fail?

It’s the first question you’ll ask yourself and understandably so because you will want to improve on what you missed.  However, for many students they clearly can’t understand why…..they performed the correct OMT modality, they completed their SOAP notes on time, they made the SP smile….so what happened? We may never know exactly why one fails their PE but it could include some of the following:

HUMANISM

  • Failure to greet the patient and thank them for waiting
  • Failure to make them feel more comfortable if they are in distress
  • Failure to respect their privacy when it comes to gowning and draping
  • Failure to maintain good eye contact and reflectively listen
  • Failure to allow the patient adequate speaking time to answer your questions, (i.e. interrupting or rapid fire questioning)
  • Not “intervening” when they admitted to having a daily habit that could contribute to a health condition (i.e. smoking, alcohol use, poor diet)
  • Not ensuring the patient understood the assessment or reasons for questioning
  • Not appearing confident when one explains the assessment and plan
  • Not suggesting to address the pain or distress in the plan
  • Rattling on and not closing the encounter strongly.
  • Failure to suggest modifications that can help them at work or home

humanism book cover final

Humanism Prep Guide For the Boards

 

DATA GATHERING

  • Failure to address other body systems by only concentrating on the chief complaint (i.e. a left shoulder pain complaint may also need questioning regarding chest pain in addition to musculoskeletal symptoms)
  • Failure to ask associated symptoms or pertinent positives/negatives (i.e. in a patient presenting with back pain, inquiring about lower extremity numbness and tingling, incontinence, hematuria, etc.)
  • Failure to address medical symptoms that may stem from a habit they have (i.e. urethral discharge if they partake in unprotected sex)
  • Failure to address medical symptoms from a medication they may excessively take (i.e. abdominal pain or blood in the stool of a patient who takes NSAIDS often)
  • Failure to examine the appropriate body parts that could be contributing to the illness, (i.e. thyroid and carotids in a patient presenting with dizziness)
  • Asking “why” when they take excessive medication – they may be self treating another medical condition
  • Asking “why” they came in for a physical (family member may have been worried about their memory)

Data Gathering Prep Guide For The Boards

Data Gathering Prep Guide For The Boards

SOAP note

  • Failure to complete all four sections (S O A P) consistently in each case
  • Failure to address the chief complaint in all four sections (i.e. if one presents with back pain, did the note address the subjective complaints, an exam of the back, differentials of what the back pain could be, and testing/OMM in the plan that addressed the back pain?)
  • Failure to include associated symptoms (i.e. in a patient presenting with a headache, were they negative or photophobia and neck stiffness)
  • Failure to document appropriate history and physical
  • Failure to list the differentials that the presenting complaint could be (i.e. a patient presenting with fatigue may have depression, anemia, sleep apnea, hypothyroidism, antihistamine overuse)
  • Failure to include OMM, testing, medications, work modifications, follow up in the plan.

OMM

  • Failure to ask permission prior to performing the OMM
  • Failure to explain what OMM is and why one is choosing to perform it
  • Appearing “rough” in technique
  • After performing the OMM, failure to ask how the patient felt and its effect on symptomatology

 

How soon can I retake the PE?

Although most students can go online and register for their retake, most academic institutions will have guidelines on when one should sign up for the retake and prove eligibility to remediating professors.  We suggest you follow your school’s recommendations as retaking the test too soon could lead to an additional failure.

 

Failed Your COMLEX 2 PE/Step 2 CS? Here Are Your Next Steps…..

 

How many times can I take the PE?

According the NBOME website, students are allowed 4 attempts in a single year and 6 total.  However, many academic institutions may have different guidelines, so review your school’s handbook to determine how many attempts they will allow before dismissal.

Is it better to take my retake in a different city than the first one?

We have not seen any data on switching test sites and its effect on passing one’s retake.  For some students the familiarity of the testing city and neighborhood makes the retake easier.  For others a fresh city with fresh SP’s offer the placebo needed to pass. Since the average SP doesn’t remember one student specifically or their score, the effect of seeing a repeating SP is negligible.

Will I not match into residency due to my PE fail?

Most students who retake their PE and pass, go on to match into a residency.  Of course this could be more challenging if one picks a specialty that is highly competitive such as surgery.  However, overcoming a test fail is often times looked upon positively by program directors.  If the question comes up during the interview be honest and humble without blaming anyone or anything for the failure.

Will a PE failure prevent me for applying to residency this year?

Most schools have a timeline on what needs to be completed before entering the match and better yet, some have a fail-safe built into the curriculum to allow some time off for board remediation if needed.  Most schools however, want all board scores passed before entering the match, and since test scores may take 6-8 weeks to comeback after taking the exam, discuss with your school on your time needed to remediate and when to schedule your retake.

Should I take a leave of absence (LOA) to study for the PE?

If you feel you need to concentrate your efforts on passing the exam, an LOA may be of huge benefit. However, other students use their clinical rotations to help them hone in on their PE skills and prefer to keep learning while preparing for their retake.  This decision will be based on your school’s recommendations and the degree of your PE failure (i.e. one section vs multiple sections.)

Will I still be able to get letters of recommendation (LOR) from faculty if I failed my PE?

Yes….but make wise choices in choosing the faculty. Those with whom you closely worked during clinical rotations, research, or community service are good choices, especially if they liked you and you performed well around them.

 

Again, hang in there. We know you just received devastating news with your first failure,  but remember most students who study, retake their PE and pass, go on to residency.  It’s a bump in your long academic road but a small one and one that can be easily overcome.  You got this!!

 

ultimate book cover final

Great Gift!!!

The Ultimate Medical Student HandBook

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

 

 

 

 

Posted in COMLEX 2 PE, Education, Health, medical school, news

Failed Your COMLEX 2 PE/Step 2 CS? Here Are Your Next Steps…..

Image above from Riverside Community College District

 

Failing an exam is not easy, especially if it’s one of your boards.  However, these tests have been failed many times before by multiple students who go on and become very successful in their field.  So what do you do when you get the crushing news?  We take it step by step…..

COMLEX 2 PE Failures: Your Questions Answered

 

Know You’re Not Alone

Considering the countless exams you’ve taken throughout your schooling, you’re sure to wind up stumbling on a few.  And none of the boards have a 100% pass rate. So there are numerous students right now in your same shoes.  The majority of them succeed on their next attempt so odds are in your favor.  Failing a set of boards should never stop your path of becoming a physician, because odds are you will succeed next time around.

 

Data Gathering Prep Guide For The Boards

Data Gathering Prep Guide For The Boards

 

Expect to Go Through the Five Stages of Grief

As soon as you receive the failing grade you will immediately be in a state of denial.  As described above you will also feel isolated, but remember, you’re not alone.  Then you’ll become angry that a testing service or grader thought you were not worthy to become a doctor.  You’ll learn that’s not the case but it will still ruin your day, week, or month nonetheless.

Next you may go through a period of bargaining, thinking you could reach out to the testing center to appeal the grade, or pray the grade away, and when the score doesn’t change, you may fall into a depression. Finally you realize the grade is here to stay and you reach acceptance, which is a good sign and necessary to recover and eventually succeed.  Once you’ve accepted what has happened you can start planning how to rectify the situation.

Many students feel they shouldn’t go through the above stages, but how else will you begin to heal from a such a traumatizing incident?  Which brings us to….

 

Take a Moment for Yourself

Being told you fail a test hurts, and you’ll want to scream or cry. That’s normal, being you busted your butt in school for years and an exam is trying to get in your way of you reaching your goal.  But when we fall we need to get back up and brush ourselves off.   The most satisfying thing you can do at this stage is prove the testing centers wrong by passing it the next time around.  Remember you are in your final years of medical school and you overcame much bigger obstacles than this.   You got this. So now what do you do next…..

 

Notify Your School Immediately

Some programs are made aware of a time frame in which test scores come out but may not know what exact day scores are released.  So if you failed and are expecting to hear from them checking in on you, don’t. Reach out to them first but realize that not hearing from your medical school is not a sign of indifference.  Once they know you failed they can start setting up a remediation program if they have one or get you in touch with valuable resources.

 

humanism book cover final

Humanism Prep Guide For the Boards

 

Be Open To Criticism and New Instruction

Medical students are told their whole life how “smart” they are so we sometimes persist in the disbelief that we failed a test. However, if you failed, chances are you did something wrong.  So take instruction and learn from it.  Even if other doctors in your clinical rotations have taught you differently, those professors in your institution who understand the boards will have insight to help you pass the boards, which is your primary goal.

If you failed humanism/communications – practice bedside manner, confidence building, questions patients commonly ask their doctor, as well as making sure the patient understands what you’re thinking and about to order for them.

Humanism Prep Guide For the Boards

If you failed SOAP notes – practice typing speed, write out notes for multiple cases, have others grade your work to see what you’re missing.

If you failed data gathering, practice coming up with differentials or body systems and common questions to ask, and review cases of all chief complaints offered in study guides.

Data Gathering Prep Guide For The Boards

Passing a test is a game..it always has been. We learned how to play the game early on in our grade, middle and high school years but now we’re playing pro and the stakes are higher when it comes to medical boards.  Realize you need help and be open to it.

Phone a Friend

You will need support from those you love and have your back.  Don’t be embarrassed discussing this one stumble in a long line of schooling successes.  No one makes it through medical school alone, so leaning on someone is par for the course.  Plus you feel better opening up.  I’ve heard from countless students who failed their PE and CS and am here as well.

Medical students and professionals aren’t perfect and shouldn’t be expected to be.  But we are strong, resilient, and hard working.  So approach your board failure as you’d do anything in medicine.  Evaluate, assess and treat…….You got this!

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

 

 

Posted in Health, medical school, news

First Year Medical Student Dilemma….Do I Really Need to Buy the Expensive Diagnostic Equipment for Class?

Medical school is no joke. It’s one of the most expensive degrees out there.  And before one starts, they are asked to purchase equipment for their first year training that can total over $1000.  Most students are expected to purchase at minimum the following:

  • Stethoscope
  • Otoscope/Opthalmascope Set
  • Monofilament
  • Reflex Hammer
  • Light source/Pen light
  • Watch
  • Bag for items

So for year’s I’ve been asked how imperative it is that they spend the money?

Why the debate?  Well many students argue the following:

  • Most clinic settings have equipment on the walls (except for stethscope of course)
  • Most student’s can’t carry all their equipment around on clinical rotations since it’s not practical
  • Most schools train their students in groups so does each one need to purchase the items or can they share amongst a group?
  • They’ll only use the eqiupment once in class and never again in their careers.

However, arguments for purchasing the equipment include the following:

  • Your school may require it
  • Some clinics have broken equipment and you will be the one student who is ready to jump in
  • It’s advantageous to have a set at home later to use for practice on family members
  • Most of us doctors do still have our sets from medical school and its a great momento

What if I can’t afford the new equipment?

Before going online to buy second hand equipment that may not work or have a warrenty, I suggest:

  • Asking your school if there are any student discounts or scholarships to help finance the purchase
  • Ask the school if equipment can be purchased as a small group
  • Borrow (or rent for a nominal fee) from an older medical student
  • Ask your course instructor if all items need to be purchased or if some are elective

Whatever you do, however, do not go cheap on your stethoscope. You will use it thousands of times in your training and cheap ones do not do as good a job. And as a medical student lives will be at stake and your stethoscope is one of your most important tools.

Discounted items can be found here at TheMedicalStudentNetwork.com.

Finally, congrats on getting into medical school!!!!  xoxoxoxo

 

ultimate book cover final

Great Gift!!!

The Ultimate Medical Student HandBook

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

 

 

 

Posted in Education, Health, medical school, students

Creating your MSPE Characteristics for Residency Applications

For those medical students applying for residency, the student needs to provide a short list of “noteworthy characteristics” that are not listed elsewhere in their application.

The Association of American Colleges (AAMC) explains what the “noteworthy characteristics” are:

This section includes information intended to help a residency program selection committee review applicants holistically to achieve a residency class that brings a diverse set of background experiences, characteristics and perspectives.
• Provide a maximum of three characteristics highlighting the most salient noteworthy
characteristics of the student.
• This section should be presented as a bulleted list. Each characteristic should be described in 2 sentences or less. Information about any significant challenges or hardships encountered by the student during medical school may be included.
• Lengthy biographical descriptions are not recommended due to the time required for review and because these details can be found in other sections of the applicant’s portfolio (e.g., ERAS application, personal statement, letters of recommendation, interviews).
• The identification of the noteworthy characteristics can be done by each student in consultation with a designated mentor or advisor, or by the MSPE author.

So in essence, they are no more than 3 short entries highlighting a unique quality and why you possess that quality.  Even though they say a “maximum of 3” do not just write one.  I would suggest writing three.  By the time the program director reads these three short sentences, they have a better picture of you as an individual.

Topics that you can draw your characteristics from include:

  • Missions done
  • Places traveled
  • Raising a family while going to school
  • Creating a charitable/community event
  • Passion, hobby, talent
  • Personal or family challenge
  • Why you chose your research project
  • Life experiences
  • Honors and Awards
  • Leadership positions that you held and what you impressive task you completed

These are usually written in third person.

Examples of these may be:

  1. As an avid traveler (or having completed a mission), Mary is fluent in Spanish, which has helped her communicate with many of her patients during training who were Spanish-speaking only.
  2. Having come to the United States as a small boy, Ti learned English and the American culture at a young age, making new friends and excelling in his school work.
  3. John served as Events Coordinator for the ACOFP and organized a water and sunscreen passout to homeless people at risk of dehydration, heat illness and skin cancer last summer.
  4. Ryan is an avid pianist and has performed at multiple venues including local adult day care centers and charity galas.
  5. Having seen her grandmother battle lung cancer, Jaime worked with other students to put up tobacco hotline numbers on university campuses.
  6. After Breana had a scare with an abnormal skin lesion, that fortunately was not skin cancer, she devoted additional patient education on how to screen for skin cancer with many of her patient interactions as a student.
  7. Lisa participated in multiple marathons, including the Boston Marathon, completing all of them.
  8. Mark lost over 50 lbs when he discovered a plant-based diet, and now educates patients on how inclusion of vegetables is paramount to a healthy diet.
  9. Scott’s academic strength was exemplified by making the Dean’s List during both years of Basic Science, and choosing to tutor other younger students when he moved on to his clinical years.
  10. Maya actively practices yoga and many times has held yoga and meditation workshops for students after school.

So as you see you can be as creative as you wish, and don’t be afraid to “brag.” This is your time to toot your horn and make yourself stand out!  You are applying for the job of your life….prove to them you are exactly what they need for their residency program.

 

ultimate book cover final

Great Gift!!!

The Ultimate Medical Student HandBook

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

 

Posted in Education, Health, medical school

Data Gathering During a Patient Encounter Made Easy

A Peek into How Doctors Think – An Introduction to “Columns”

Anyone who is on their path to becoming a successful physician needs to be able to take a good history and perform a thorough physical.  However in this day and age, patient care is performed in a very speedily process and thus the boards test a medical student on how succinctly they can perform a patient history.

 

Thus students and licensed medical providers need to be adept at “data gathering” no matter what the patient presents with.  Our job is to figure out what’s going on, no matter how difficult the task, and do so quickly.  So how do we accomplish this?

We start by looking at the cause and then breaking down what could be occurring resulting in that cause, or in other words, forming a differential diagnosis.  So if someone has chest pain, one may form a differential consisting of heart attack, pericarditis and costochondritis. But other issues may be at play such as a pneumonia or an esophagitis.

So when we look at a person with chest pain, we consider all the body parts or causes that could be causing the symptoms.

Hence with a patient presenting with chest pain, one would consider a cardiovascular cause, pulmonary cause, gastrointestinal cause, musculoskeletal cause, and even psychiatric cause.

This is the basis of forming one’s columns. For every chief complaint we form columns either mentally or on paper and then ask associated symptoms (or pertinent positives or negatives) to determine which column we’re in.  Usually a few “power questions” will help discriminate which column you are in. Once you hit the correct column you will ask further questions along that line.

Data Gathering Prep Guide For The Boards

Data Gathering Prep Guide For the Boards

True there are many more questions we could ask than just the “power questions,” but during a time crunch we need to ask very specific ones to determine if we are on the right track.  If we receive multiple “no”s along a column, we know to move onto the next column.

Hence if a patient with chest pain denies dizziness and diaphoresis or sternal pain upon palpation but admits to cough, shortness of breath and sputum production, we have just narrowed down the chest pain patient to a pulmonary cause as opposed to assuming it was cardiac in nature. Then we would continue down the pulmonary column, thinking our differential may be a pneumonia/bronchitis/pulmonary embolism, and ask about hemoptysis, fever, chills, etc.

humanism book cover final

Humanism Prep Guide For the Boards

So for each patient one must create columns depending on the chief complaint and then ask power questions to help focus down your differential.

Now these columns can also assist with the physical exam component of data gathering.  If the above patient presenting with chest pain could have a cardiac/pulmonary/GI/musculoskeletal condition, one would examine his heart, lungs, upper abdomen and palpate the sternum and ribs.

For an added bonus, the columns can additionally assist one in forming their differential for the SOAP note. 

Chest pain r/o

  • Pneumonia
  • Bronchitis           
  • PE
  • MI
  • GERD
  • Costochondritis

If a case involves a not so clear-cut symptom, columns could be used as well.

For example a patient presenting with hair loss.  If one complains of hair loss, a variety of differentials could be at play.  One column could be an endocrinology source (such as hypothyroidism or diabetes), another could be psychological (such as stress or trichotillomania), a third could be medications (such as chemotherapy agents), and a fourth could include genetics.  Narrowing these down with power questions could exclude non-contributing columns.

So whether it’s a direct body system or cause, columns help one focus down the differential and allow an easy visual that enables one during a timed test to think quickly and know which questions to ask.

Again these columns are instituted after the History of Present Illness in which a student obtains onset/chronology, palliative/provocative factors, quality of symptoms, radiation, severity and timing (OPQRST).

They will be written down in the SOAP note after the HPI.  

Example:  Mary is a 25-year-old female presenting with acute onset right foot pain.  It began 6 hours ago after she went for a job. Ice provides some relief but walking on it worsens the pain.  The pain is sharp, constant with a severity of 7/10. She denies fever, chills, open wounds, swelling, redness, temperature changes, numbness or tingling.

Since during this step in the history most medical students find it challenging to know “which questions to ask.”  The columns and power questions simplify this.

To learn this method to improve one’s data gathering skills click here.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.