The Short Case

What is the short case?

Why is the short case so weird and stressful.…

How to make the short case less weird and stressful…..

How to begin (the general inspection)

This initial interaction will help relax you, the patient and the examiner:  It is a critical point of the short case.  It should appear deliberate and purposeful (even if it is only for a brief period of time).  

  1. Hello, my name is Dr. X, before I examine you (or your child) closely I would like to take a general look at you or look at your breathing.
  2. Stand back in a relaxed but studied approach – hand on chin, head cocked to one side like Sherlock Holmes investigating a crime scene. Move you head/eyes in deliberate way from head to torso. Step around or behind the bed as necessary, look deliberately at oxygen flow rates, infusions, sputum pots walking aids and other visual clues.
  3. Good, now I would like to have a closer look, ‘May I have both of your hands’…..


Make a brief statement (but don’t prattle on) if there is a startling clue on initial inspection (otherwise proceed quickly to the examination) e.g.

Point to a visual cue e.g. set of calipers and say ‘I presume these belong to you’'
"Mmm, I notice your face looks a bit flushed or your lips look a little dusky’"
Oh, that’s an interesting sound, it seems to be coming from your heart. I would like to listen to than in a moment..
’‘You look like you are a little out of breath, Is it OK for me to examine you"
’‘My you seem to be covered with quite a few bruises"
"That tremor must be really bothering you.’‘
"Looks like you are having some trouble with your breathing’"

Make your commentary in a rhetorical way rather actually expecting the patient to answer

This reassures the examiner that your general inspection is already giving you important information and you are confident with your signs. It is also a good icebreaker with the patients, builds rapport and makes it easier to progress….

Further examination (after the hands)

Examples:

Examine this patient’s cardiovascular system …I would now like to take your pulse
Examine this patient’s abdomen ……let me have a good look at your tummy…while I am doing that can you cough for me.
Examine this patient’s limbs/joints ……let me have a closer look at your hands/feet/knee/hip.  I would like to feel them, let me know if I cause you discomfort.  Can show what you can do with them.  I would now like to now move them for you.
Examine this patient’s cranial nerves ….I would like to take a closer look at your face and do some tests
Examine this patient’s eyes/vision ….let me have a closer look at your eyes… I would now like to test your eyesight
Examine this patient’s speech ….I would to evaluate your speech a bit futher


Key into major symptoms

It is worth briefly commenting about a clearly obvious sign then proceed quietly through the rest of the examination"….that’s an interesting clicking coming from your chest...I will to need to listen carefully""….that liver certainly feels enlarged….I will like to feel a bit more closely, tell me if it becomes uncomfortable""…..looks like you have a bit of squint….I will need to have a better look at your eyes….""…..those joints look at bit swollen/sore…. I will like to examine them a little more closely, tell me if it becomes uncomfortable"

Questions about style