History Taking and Anatomical Planes & Movements SESSION 1 9th February 2011

History Taking and Anatomical Planes & Movements SESSION 1 9th February 2011

Tutors’ Welcome Ieuan Reece Chuan Zhang Jennifer Kwan JoanidFarid Chole Thompson Lauren Toms Paul Dodds Andrew Mabey Anna weatherill Alexandra Dunlop

Aims of Doc-to-Doctor? Help integrated knowledge from across modules using ESA style questions To teach history taking and clinical examination Provide consistentpractice of history taking and clinical examination

How will this be achieved? Work in small groups, each assigned to a tutor Structured, scenario based questions which incorporate: History taking Clinical examination Short answer questions on the previous weeks lectures, and ESA 1 content Hints, tips and memory aids You may not be able to get through all questions each week

Doc-to-Doctor is NOT: A substitute for self-directed learning Going to cover all learnt material from the current Semester Suggestive of content in ESA 2

PATIENT HISTORY EACH WEEK Clinical Skills 1: Anatomical Planes, Relations and Movements 2: Cardiovascular Examination 3: Shoulder Examination 4: Blood Pressure and Pulse Points 5: Dermatomes of the Upper Limb 6: Cardiovascular Exam 7: Shoulder Examination 8: Hip Examination 9: Knee Examination and Blood Pressure 10: Hip Examination

Structure of the Session

History Taking - Basics Introduce yourself: Full name, position and intent “Good morning/afternoon Mr Smith, please take a seat. My name’s X and I’m a first year medical student, here at Leicester. I was just hoping I could have a chat with you today before you go in to see the doctor” Gain consent and thank patient “Would that be okay?” Confirm patient’s full name, DOB and occupation “Before we begin, Mr Smith, could I just take your full name, DOB and occupation please?” Retired?

HPC Begin with these two open questions: “Why have you come to see the doctor today” “Can you tell me a bit more about that please?” SQITAR(P)S Site: Where exactly? Radiation? Quality: Description of how the pain feels Intensity: How has the pt. been affected? Timing: Start? Onset – sudden/insidious? Changed with time? Why now? (Happened previously?) Aggravating factors: What makes it worse? Relieving factors: Anything that makes it better? Previous episodes Secondary symptoms – ? >1 symptom

Summarise Pt. should think this is for your benefit: “To check I haven’t misunderstood anything, I’m just going to go over what you’ve told me so far” When reflecting back, use the SQITAR(P)S layout, so you’ll notice if you’ve missed anything out. Finish with: “Is there anything you’d like to tell me at this point?”

ICE Ideas: “Do you have any ideas about what this could be?” Concerns: “Is there anything in particular that you’re worried about?” Expectations: “What is it you’d like to take away from the doctors today?” LEICESTER IS VERY BIG ON THIS

PMHx DHx Have they been well recently? Any other serious illness before? Have they ever been in hospital? When, why and for how long. Are you currently being treated for anything? • Currently taking prescribed medications? • Ever been on long term medication? • When, why and for how long. • Any OTC drugs • Allergies? i.e. Penicillin;Elastoplast • If appropriate – Illicit drug use

FHx SHx Are there any problems which run in the family? Health of: Mother and Father/Siblings Siblings Spouse Children • Smoking? Pack-years • Alcohol? Ask pt. to describe their understanding • Dietary habit? • Living conditions and support • Hobbies • Occupation and financial stability - clarify

Finishing the Interview You may wish to summarise again Ask the pt. if they’d like to add anything Thank the pt. and show them to the doctor’s room

Hints & Tips Try and maintain a good structure, but do not interrogate the pt. SQITAR(P)S must be satisfied, but you do not have to do it in this fixed order – go with the patient If pt. has more than one symptom, take a Hx of them both independently Be empathic Don’t try and think of questions whilst the patient is speaking – just listen and the questions will come easier.

If you get stuck… There are a few things you can do Panic….. Ask the patient if the patient a if you can just gather your thoughtsfor a minute. Summaries what they have said

If you get stuck… There are a few things you can do: Panic… Reflect back to the patient, using SQUITAR(P)S layout – this way you’ll realise what you’ve left to ask Ask for a second to think

Explanation • 1 Station in the year 1 OSCE • Explanations can be on diseases or investigations.

How to start • Introduce yourself and state your intentions • Check what the patient wants to be called • Ask the patient what they already know

Hints and Tips • Small pieces of information • Check the patients understanding • Respond to the patients verbal and non verbal cues. • Avoid jargon. • Don’t blag it

How to end explanation • Summaries everything you have said • Ask the patient if they have any more questions. • Give them a leaflet with the information

Coronal • Horizontal • (Mid)Sagittal Anatomical Planes http://www.anatomy.tv/StudyGuides/StudyGuide.aspx?guideid=9&NextID=0&customer=primal

Proximal/Distal • Superficial/Deep • Medial/Lateral • Superior/Inferior • Anterior/posterior Anatomical Relations

Anatomical Movements Flexion/Extension – Narrowing/increasing the angle of a joint Abduction/Adduction – Movement away/towards the midline Medial rotation/Lateral rotation – Rotary movement about the longitudinal axis of a bone Lateral flexion

Anatomical Movements Ankle: Dorsiflexion/Plantarflexion/Inversion/Eversion Scapula: Protraction/Retraction Mandible: Protrusion/Retrusion Thumb: Opposition/Flexion/Extension/Abduction/Adduction

QUESTIONS?

Groups

History Taking and Anatomical Planes & Movements SESSION 1 9th February 2011