For new comers....
Knock 3 times with confidence , a smile , walk in and say "good morning Mr. Smith, I am Dr.Digi_Doc and am here to see you as your physician." Shake hands with the patient, look around the room and say "Is everything in the room alright for you ?" - SP will say yes - Then you say "Let me make you a little more comfortable".....and while saying so, drape the patients legs up to his belly.
Then say "So Mr. Smith, how may I help you?" After the patient tells you the chief complaint, Say " Hope you dont mind if I make a few notes as you speak" This makes you free to write or pretend to write as your try to recall what to ask without showing ur nervousness - actually a good time to write ur mnemonics !! For an elderly patient, You may sit on a stool and bend forwards as if listening - i did so because it created a feeling of showing humility and friendliness.
After finishing off with data collection "PAM HUGS" before you move on to "FOSS" it is good to say " Mr. Smith, the way clinical medicine works, there could be some clues hidden in a few personal questions I need to ask you - are you OK with that ? " and then move on to family history, drinking, smoking, social , sexual history. if you have finished, do give the patient a final chance by saying " Is there anything else you want to tell me ?" then move on to examination.
Dont ever express explicitly that you have concluded your questioning, because you might remember something during physical examination and it is ok to ask then ! I had reserved the time to wash my hands to enquire about occupation and say "thats interesting, my uncle used to do something similar' or something like that.
Before you begin physical examination say "I will now need to perform a quick general examination and then let us look at your chest [or abdomen - wutever the chief complaint is]" and do keep talking during each thing your examine - like "lets look at your eyes, could you look up for me" while examining pallor. By the way , a good mnemonic of quickly completing general examination is "PICKLE" Pallor, icterus, Cyanosis, Koilonychia, Lymphadenopathy and Edema Feet" along with Jugular veins, carotid bruit if CVS case.
At the end of Physical Examination, summarise : "Based on what you told me and your physical exam, there are certain diagnostic possibilities like 1._____, 2. ________ or 3. _______ and some more. Let us order a few tests to be more certain, like blood tests, chest x-ray , an EKG , and then discuss further management. "
while concluding, keep this 4-stage pattern in mind :
First Counsel !!! For example - for a case of diabetes, it is good to say a few words on foot care ! if the patient smokes or drinks alcohol - say "are you aware of the harmful effects of smoking / alcohol ? Have you ever considered quitting - if you wish to , we have a good support team that is willing to help you quit the habit" thats it - dont get personal about it
Then say " Have you understood everything we have discussed today ?"
Then " Are there any special concerns you have ?"
finally " Thankyou very much Mr. Smith . I shall leave my contact information with my nurse - feel free to contact me anytime if you have any questions"
In case the times gets over and you have to leave, dont make it abrupt, rather it is good to pretend looking at your beeper and say "Oh ! Mr. Smith, We have an emergency and I have to leave - I will see you as soon as I get free" and leave.
Hope this helps