Long Case
From RACP
Patient 60mins
- ? harris suggest 20mins Hx, 10 mins Ex, rest organising plan)
Prep 10mins
Present 25mins (give sticker)
- ? suggestion 8mins Hx, 2mins Ex, 1 min Summary, then Management
(med list, urinalysis, DRE will be provided as required)
(don't ask parents to leave, don't use bulldog)
RECORD YOURSELF
-----------------------------------------------------------------------------------------------
Who did the examiners take the history from?
What are there strengths?
Introduction
I have just seen [name of child], a [age in months or years] old boy/girl with a [duration of time] history of [presenting complaint], who is currently in hospital for [reason for being in hospital that day].
[Name of child]’s problems include [list of each diagnosis in order of importance, or in the case of a multi-system disease, each aspect as it arose in chronological order]. I shall discuss the history of each problem in this order
Hx
age, date of birth, home address. distance to closest medical services
Is your child an inpatient at the moment
What is the primary diagnosis / other clinical problems (active / inactive)
- Specific inquiry of system involvement.
What doctors look after them (list of specialists)
Initial symptoms, investigations and management prior to diagnosis
diagnosis (date or age, where, how)
subsequent investigations and management
progress of the disease, recent change
hospitalisation details (frequency, duration, usual treatment)
complications of the disease
Side effects of treatment
outpatient clinics attended (where, how often, routine tests performed)
recent change in symptoms or management.
Have there been any discussions about what the future might hold
Are there any resuscitation plans
PMH
PSH
PPH
POH
Antenatal Hx
Conception
Bloods, US, issues/Rx
Birth
NVD after SOL at Gestation
APGARs, SCN
wt, lth, HC
Feeding: BF, Bottle, solids
Hydration
Diet:
Toilet training
Sleep
Development
Hearing
Vision
work down gross motor, then sideways to correlate
3mo: head up 45, follow past midline, laugh and smile
6mo: roll, reach for rattle, turn to rattle, work for rattle
9mo: sit, take 2 handfuls of food, one syllable (ba) feed self
12mo: stand, pincer, repeat syllable (baba), pat-a-cake
15mo: walk, animal in box, papa, bye-bye
18mo: walk backwards, scribble, 3 words, drink from cup
2y: walk up 2 stairs, 2 cubes, combine 2 words, spoon
3y: 3pointer (jump 2 feet and throw over arm) 6 cubes, 6 part body, half speech understandable, Wash, dry hands(3 things cleaned)
4y: balance one foot, thumb war, name 1 colour, T-shirt on
5y: Hop one foot, 3 part person, name 4 colours, Dress
6y: Heal-toe, 6 part person, count to 5, Brush teeth
ADLs
List of medications
Alternative medicine
Compliance
Levels
Allergies, Side effects
Immunisation history.
FH (A MZ, ^ DZ, half, X death, // divorce, --- living together, foster)
GP,MS,TOP
Planning any more
Social history:
(NB emphasise that won't pass on information unless concerns that pt being harmed/plans to harm self or others)
Carer
family income
Home, car,
financial support, private health
Social isolation
DV/SA
Unmanaged mental/physical illness
Drug OH
Gambling
Risk assessment
Protective factors
Forensic, police, FACS
School / missed
Work / missed
work/ aspirations
School, Grade, missed, repeated
Subjects grades
sport, extracurricular
friends, there understanding
quality of relationships in tree
siblings’ reactions to the patient’s illness
Parents social life, holidays, respite
Immigration, language, supports
Association
Systems Review
SW
OT: mobility, transport, home, school mods
Physio
dietitian
GP
Paed
Specialist
Rx Routine
Is there anything they discussed that we haven't discussed
Ex (focus on problems, then systems review)
(Present like short case)
General apperance
Centiles
Vital signs and UA
Safety
- swallow
- raised ICHTN
Teeth and skin
UA
Is there anything they examined that we haven't examined
Problem list (What is worrying child, parent, doctors most)
- order of importance
- Ix to confirm Dx
- Mx plan
3x3 grid short, medium, long term v bio, psycho, social
Is there anything else that that you think is relevant, or that anyone else has asked about or examined today, or previously
Parents understanding
?Steroids stress letter
Inconsistancies?
Don't know the answer to a question: That is an important question, that I had not got to while focusing on other issues, but something that I would like to follow-up on at the next visit.
Siblings Australia
Prematurity
CF
Patient 60mins
- ? harris suggest 20mins Hx, 10 mins Ex, rest organising plan)
Prep 10mins
Present 25mins (give sticker)
- ? suggestion 8mins Hx, 2mins Ex, 1 min Summary, then Management
(med list, urinalysis, DRE will be provided as required)
(don't ask parents to leave, don't use bulldog)
RECORD YOURSELF
-----------------------------------------------------------------------------------------------
- History: Structured presentation of detailed history, sophisticated interpretation, mature understanding of complex issues, without repetition
- Examination: Systematic complex exam including subtle signs and pertinent negatives
- Issues: Sophisticated synthesis of issues with short and long term view
- Impact: Understanding of patients physical and psychological functioning, and social impact of issues and prognosis on pt and family (9 box this)
- Management Plan: Discriminating use of investigations, discerning interpretations and complex management plan (non pharm, pharm, surg, other) including monitoring for side effects , prognosis,
Who did the examiners take the history from?
What are there strengths?
Introduction
I have just seen [name of child], a [age in months or years] old boy/girl with a [duration of time] history of [presenting complaint], who is currently in hospital for [reason for being in hospital that day].
[Name of child]’s problems include [list of each diagnosis in order of importance, or in the case of a multi-system disease, each aspect as it arose in chronological order]. I shall discuss the history of each problem in this order
Hx
age, date of birth, home address. distance to closest medical services
Is your child an inpatient at the moment
What is the primary diagnosis / other clinical problems (active / inactive)
- Specific inquiry of system involvement.
What doctors look after them (list of specialists)
Initial symptoms, investigations and management prior to diagnosis
diagnosis (date or age, where, how)
subsequent investigations and management
progress of the disease, recent change
hospitalisation details (frequency, duration, usual treatment)
complications of the disease
Side effects of treatment
outpatient clinics attended (where, how often, routine tests performed)
recent change in symptoms or management.
Have there been any discussions about what the future might hold
Are there any resuscitation plans
PMH
PSH
PPH
POH
Antenatal Hx
Conception
Bloods, US, issues/Rx
Birth
NVD after SOL at Gestation
APGARs, SCN
wt, lth, HC
Feeding: BF, Bottle, solids
Hydration
Diet:
Toilet training
Sleep
Development
Hearing
Vision
work down gross motor, then sideways to correlate
3mo: head up 45, follow past midline, laugh and smile
6mo: roll, reach for rattle, turn to rattle, work for rattle
9mo: sit, take 2 handfuls of food, one syllable (ba) feed self
12mo: stand, pincer, repeat syllable (baba), pat-a-cake
15mo: walk, animal in box, papa, bye-bye
18mo: walk backwards, scribble, 3 words, drink from cup
2y: walk up 2 stairs, 2 cubes, combine 2 words, spoon
3y: 3pointer (jump 2 feet and throw over arm) 6 cubes, 6 part body, half speech understandable, Wash, dry hands(3 things cleaned)
4y: balance one foot, thumb war, name 1 colour, T-shirt on
5y: Hop one foot, 3 part person, name 4 colours, Dress
6y: Heal-toe, 6 part person, count to 5, Brush teeth
ADLs
List of medications
Alternative medicine
Compliance
Levels
Allergies, Side effects
Immunisation history.
FH (A MZ, ^ DZ, half, X death, // divorce, --- living together, foster)
GP,MS,TOP
Planning any more
Social history:
(NB emphasise that won't pass on information unless concerns that pt being harmed/plans to harm self or others)
Carer
family income
Home, car,
financial support, private health
Social isolation
DV/SA
Unmanaged mental/physical illness
Drug OH
Gambling
Risk assessment
Protective factors
Forensic, police, FACS
School / missed
Work / missed
work/ aspirations
School, Grade, missed, repeated
Subjects grades
sport, extracurricular
friends, there understanding
quality of relationships in tree
siblings’ reactions to the patient’s illness
Parents social life, holidays, respite
Immigration, language, supports
Association
Systems Review
SW
OT: mobility, transport, home, school mods
Physio
dietitian
GP
Paed
Specialist
Rx Routine
Is there anything they discussed that we haven't discussed
Ex (focus on problems, then systems review)
(Present like short case)
General apperance
Centiles
Vital signs and UA
Safety
- swallow
- raised ICHTN
Teeth and skin
UA
Is there anything they examined that we haven't examined
Problem list (What is worrying child, parent, doctors most)
- order of importance
- Ix to confirm Dx
- Mx plan
3x3 grid short, medium, long term v bio, psycho, social
Is there anything else that that you think is relevant, or that anyone else has asked about or examined today, or previously
Parents understanding
?Steroids stress letter
Inconsistancies?
Don't know the answer to a question: That is an important question, that I had not got to while focusing on other issues, but something that I would like to follow-up on at the next visit.
Siblings Australia
Prematurity
CF