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- Feb 3, 2016
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Sorry this is long- freak out mode. Type A personality
I just took PE the other day and i am freaking out about this now. I felt like i started off with the first four patients doing well and then it suddenly went down hill. My biggest concern is that there were two patients where i did not get to discuss my diagnosis or plan with at all (counsel). One of them asked for OMM and i was listening to her lungs when the 2 min bell went off and quickly tried to get to OMM, bell went off and i had to leave her on the table . Fastest two minutes ever, i didn't even know if i was allowed to say thank you after time was done. The other patient i just got so hung up on asking her neuro symptoms and time just ran out, god i feel like such an idiot, just said thanks and left her there with no answer. All of the other patients i was able to counsel on my diagnoses, some of which may have been off base but showed confidence. I feel like i clicked well with 11/12 of the patients, on a personal level I do pretty well with talking to people, my issue is lack of time.
Things I messed up:
- not being able to counsel those two above patients at all
- did not introduce myself beyond my name to one patient because she start rambling immediately.
- didn't check thyroid in a fatigue case that was hard to figure out
- didn't counsel about smoking cessation in a couple smokers (i think i may have put it in the plan though to do it next time) but then another time i would counsel but did not put "tobacco abuse/ alcohol" in my Ddx or plan of what i did
- had only two diagnoses for one case
- did a lot physical exam stuff in some encounters but was unable to document due to time constraint. did like three HEENT exams but only documented it one time.
- weak differentials and plans i think ( i would get stuck on my first diagnosis and have a hard time coming up with more because of time stress)
- did not document vitals in probably like 4 cases (it was one of the last things i did and just couldn't get time to go back)
- asking if someone has any questions is something i normally do but now thinking about it i worry that i didn't do it for everyone. (obviously not the two patients i didn't get to counsel)
- there were a couple subtle diagnosis that the patients hinted at but i did not pick up. (ie. having to stop a medication because of some SE--> drug-induced XXX)
-didnt evaluate ROM of a stiff neck in someone who asked about OMM, I just laid them down and did OA and myofacial, and then did ROM after, wrote in my note that to evaluate neck further prior to OMM at next visit.
Things i did >90% of the time
- introduced myself
- shook their hand
- wash my hands
- always asked if i could do the physical
- always asked to undrape them
- always listened on skin
- showed some sort of compassion be it apologizing about a dead family member or about their pain, asking about any kids, or more about their job, making a light joke, etc.
- told about half the patients at the end that "i am always here for you if you need someone to talk to and i can bring back some contacts that may help as well" (something like that)
- always draped for abdominal exams
- made good eye contact
- was very good about following OPPQRSTA and SMASHFM (forgot radiation in one important case)
- was friendly
- thanked them and shook their hand again at the end of the encounter (10/12 cases)
- Subjective portion of documentation- always thorough, full sentences, all parts of SMASHFM every time
- acted confident, held myself well.
subjective portion of the documentation is the only part i am confident on... hate that time was just so difficult for documenting. some DDX were good, some terrible. Some plans were decent, some not. Objective- always had full heart and lung exam. if abdominal case- documented abdomen. Always had a general observation, but like i said before missed putting vitals on 3-4 of them. OMM felt decent enough.
now that I've picked out every possible thing i think i did wrong, it sounds like i really failed. Note that i am most definitely a NORMAL human being and i have no language barrier. All my attendings love me. I'm good at making people feel comfortable talking to me, and when i listen to someone i make constant eye contact and nod, and smile if warranted.
if anyone can share their "disastrous" experiences and did pass please let me know. Im freaking out cause i would like to do something competitive. I should have waiting longer, I'm a 3rd year still.
I just took PE the other day and i am freaking out about this now. I felt like i started off with the first four patients doing well and then it suddenly went down hill. My biggest concern is that there were two patients where i did not get to discuss my diagnosis or plan with at all (counsel). One of them asked for OMM and i was listening to her lungs when the 2 min bell went off and quickly tried to get to OMM, bell went off and i had to leave her on the table . Fastest two minutes ever, i didn't even know if i was allowed to say thank you after time was done. The other patient i just got so hung up on asking her neuro symptoms and time just ran out, god i feel like such an idiot, just said thanks and left her there with no answer. All of the other patients i was able to counsel on my diagnoses, some of which may have been off base but showed confidence. I feel like i clicked well with 11/12 of the patients, on a personal level I do pretty well with talking to people, my issue is lack of time.
Things I messed up:
- not being able to counsel those two above patients at all
- did not introduce myself beyond my name to one patient because she start rambling immediately.
- didn't check thyroid in a fatigue case that was hard to figure out
- didn't counsel about smoking cessation in a couple smokers (i think i may have put it in the plan though to do it next time) but then another time i would counsel but did not put "tobacco abuse/ alcohol" in my Ddx or plan of what i did
- had only two diagnoses for one case
- did a lot physical exam stuff in some encounters but was unable to document due to time constraint. did like three HEENT exams but only documented it one time.
- weak differentials and plans i think ( i would get stuck on my first diagnosis and have a hard time coming up with more because of time stress)
- did not document vitals in probably like 4 cases (it was one of the last things i did and just couldn't get time to go back)
- asking if someone has any questions is something i normally do but now thinking about it i worry that i didn't do it for everyone. (obviously not the two patients i didn't get to counsel)
- there were a couple subtle diagnosis that the patients hinted at but i did not pick up. (ie. having to stop a medication because of some SE--> drug-induced XXX)
-didnt evaluate ROM of a stiff neck in someone who asked about OMM, I just laid them down and did OA and myofacial, and then did ROM after, wrote in my note that to evaluate neck further prior to OMM at next visit.
Things i did >90% of the time
- introduced myself
- shook their hand
- wash my hands
- always asked if i could do the physical
- always asked to undrape them
- always listened on skin
- showed some sort of compassion be it apologizing about a dead family member or about their pain, asking about any kids, or more about their job, making a light joke, etc.
- told about half the patients at the end that "i am always here for you if you need someone to talk to and i can bring back some contacts that may help as well" (something like that)
- always draped for abdominal exams
- made good eye contact
- was very good about following OPPQRSTA and SMASHFM (forgot radiation in one important case)
- was friendly
- thanked them and shook their hand again at the end of the encounter (10/12 cases)
- Subjective portion of documentation- always thorough, full sentences, all parts of SMASHFM every time
- acted confident, held myself well.
subjective portion of the documentation is the only part i am confident on... hate that time was just so difficult for documenting. some DDX were good, some terrible. Some plans were decent, some not. Objective- always had full heart and lung exam. if abdominal case- documented abdomen. Always had a general observation, but like i said before missed putting vitals on 3-4 of them. OMM felt decent enough.
now that I've picked out every possible thing i think i did wrong, it sounds like i really failed. Note that i am most definitely a NORMAL human being and i have no language barrier. All my attendings love me. I'm good at making people feel comfortable talking to me, and when i listen to someone i make constant eye contact and nod, and smile if warranted.
if anyone can share their "disastrous" experiences and did pass please let me know. Im freaking out cause i would like to do something competitive. I should have waiting longer, I'm a 3rd year still.