Learning how to present a patient

Communicating with other doctors about a patient is a critical skill in medicine, one that is typically developed during the third and fourth years of medical school and honed during internship. The idea is to tell the patient's story in such a way that all relevant objective information is included, without editorializing, but the listener is able to form an idea in his or her mind the likely diagnosis and a list of other possible diagnoses.

It can be frustrating for medical students to develop this skill - it certainly has been frustrating for me. When I'm presenting a patient, I have the sense that my presentation is jumbled and inefficient, but I don't have a clear idea of how to improve it without losing the quality of information I'm trying to convey. Or, I know how I could improve the presentation but am not yet quick enough on my feet to do it on the spot.

I got two new patients yesterday while on call. I worked them up (which means interviewing them and doing a physical exam) and presented them to my intern. This first run-through was informal and messy but really served to help me organize my thoughts for when I would present to my resident.

My resident asked me to give a more formal presentation. These can be a little anxiety-provoking for me because it's a one-way communication rather than a conversation. I talk uninterrupted even if what's coming out of my mouth is pure garbage; if I pause to gather my thoughts, the person listening stays quiet rather than filling that pause with a question. Longer pauses can become very uncomfortable.

After finishing my presentation, my resident said, "Good! That was good. But let me tell you how you can make it better." We then went through my presentation section-by-section, highlighting ways in which I could better organize the information to tell a more clear story or present that information more concisely.

"Now present to me again." Really? Listening to a third-year medical student present a patient can be a painful experience. I've gotten plenty of feedback on my oral presentations in the past, but no one had ever asked me to present to them again immediately afterward.

So I presented to my resident a second time, and that presentation was much more organized. "Good! That was much better. But I'm going to show you how you can take it to the next level." We then went through my presentation a second time. He talked more about what the person listening to my presentation expects to hear, and when, in order to form a clear clinical picture in his or her mind. He also talked about how to more strategically present certain information, or leave out other information, in order to guide my listener along a particular line of thought.

"Now present to me again." Again? "Incredible!" I thought to myself as I prepared for the third presentation. This teaching process could have been intimidating if my resident were not so nice and laid-back.

One of my interns had been sitting nearby while this was all happening. When we finished, she came over to tell me how lucky I am: "What he's doing is amazing. No one ever did this for me, but I wish someone had."

I do realize how lucky I am that my resident took the time to teach me how to present a patient well. Not only that, but he did a really good job teaching me. First, let me make all my mistakes. Next, point out my mistakes and tell me how I can fix them. Next, let me try it again, hopefully making fewer mistakes than before. Then, repeat.

Before that session, I had felt like I was spinning my wheels in my efforts to improve my presentation skills. Now I feel that I have some traction.