Working in the outpatient clinic is a key training experience for medical students. When they arrive at the clinic, students may discover that their time on the inpatient wards does not necessarily prepare them to perform well in the outpatient setting. Everything is different in the clinic, from the nature and context of the patient encounter to the student’s role in note-writing, oral case presentation, and case discussion with the attending physician. The purpose of this book is to guide students as they transition to the world of 15-minute appointments, telemedicine, cyberchondriasis, motivational interviewing, shared medical appointments, and real-time informatics. The aim is to give students a clear understanding of their role in a variety of clinic settings, to evaluate and present their patients well, maximize learning, and provide excellent care for their patients. Excelling in the Clinic explains the process of becoming an effective, efficient, and scholarly worker in the primary care clinic.
Author(s): Clifford D. Packer
Publisher: Springer
Year: 2022
Language: English
Pages: 187
City: Cham
Preface
Contents
1: The Importance of Primary Care
1.1 The Power of Incremental Care
1.2 Effects of High-Quality Primary Care on Health Outcomes
1.3 The Long-Term Physician-Patient Relationship
1.4 Seeing the Big Picture
References
2: Medical Education in the Outpatient Clinic: Benefits and Barriers
2.1 Benefits: Role Modeling, Mentoring, and One-on-One Teaching
2.2 Barriers: Stressed Clinical Preceptors and Student Preconceptions
References
3: Clinic Settings, Schedules, and Structures
3.1 Settings
3.2 Schedules
3.3 Structures
3.4 Other Clinic Experiences
References
4: COVID-19 and the Rapid Rise of Telemedicine
4.1 How COVID-19 Has Changed Primary Care
4.2 Telephone and Video Visits: Benefits and Limitations
4.3 Student Participation in Telemedicine
4.4 Telemedicine Is Here to Stay
References
5: Role of the Student in the Outpatient Clinic
5.1 Active Versus Passive Clinic Experiences
5.2 What Your Clinic Attending Is Looking For
5.3 Increasing the Level of Responsibility: The RIME Framework
5.4 Working with the Clinic Staff
5.5 Following Up on Test Results and Consults
References
6: Preparing to See the Patient
6.1 Chart Review and Creating an Agenda for the Visit
6.2 More Thoughts on the Agenda: “I Just Want to Know If I’m Healthy Enough for Bacon”
References
7: The Patient-Centered Interview
7.1 Basics of the Patient-Centered Interview
7.2 Greeting and Introduction
7.3 Begin with an Open-Ended Question, and Listen Carefully to the Answer
7.4 Look at the Patient, Not the Screen
7.5 Med Reconciliation
7.6 Evaluate New Symptoms with Pertinent Positives and Negatives
7.7 Review of Systems
7.8 Using Motivational Interviewing for Behavioral Change
7.9 Dealing with Talkative, Angry, and Distracted Patients
7.10 Cyberchondriasis
7.11 Shared Decision-Making
References
8: The Physical Exam
8.1 (Lack of) Evidence for the Routine Physical Exam
8.2 The Irrational Physical Exam?
8.3 Checking Your Exam Findings with the Attending
8.4 Point-of-Care Ultrasonography in the Primary Care Clinic
References
9: The Concise Oral Case Presentation
9.1 The SOAP-Style Oral Presentation
9.2 Schema for the Oral Case Presentation in the Clinic
9.3 Using the Problem List as a Guide
9.4 Examples of Oral Presentations
9.4.1 The Routine Follow-Up Visit
9.4.2 The Posthospital Visit
9.4.3 The Urgent Visit
9.4.4 The New Patient Visit
References
10: Discussing the Case
10.1 Identifying Key Learning Points from the Case
10.2 Using SNAPPS for Case Presentation, Discussion, and Teaching
10.2.1 Standard Case Discussion
10.2.2 SNAPPS-Style Case Discussion (Same Patient)
10.3 Researching the Case and Reporting Your Findings
10.4 Questioning Dogma in the Clinic
10.5 Responding to Feedback
References
11: Writing a Clinic Note
11.1 The Classic SOAP Note and Its Function
11.2 How Not to Write a Progress Note: Things to Avoid
11.3 Examples of Concise Clinic Notes
11.3.1 Note #1. 55-Year-Old Woman
11.3.2 Note #2. 71-Year-Old Man
11.3.3 Note #3. 71-Year-Old Woman
11.3.4 Note #4. 67-Year-Old Man
11.3.5 Note #5. 74-Year-Old Man
11.3.6 Note #6. 55-Year-Old Man
11.3.7 Note #7. 66-Year-Old Man
11.3.8 Note #8. 92-Year-Old Man
12: Service-Learning Clinics
12.1 Working in Shelters and Homeless Clinics
12.2 Student-Run Free Clinics
12.3 Challenges and Satisfactions of Caring for the Underserved
12.4 The Silver Chalice
References
13: Careers in Primary Care
13.1 Traditional, Nontraditional, and Academic Practice Options
13.2 Finding Your Niche in Primary Care
13.3 Academic Careers in Primary Care: How to Get There
13.4 The Future of Primary Care
References
Subject Index
Author Index
