How to be more thorough?

[u/rash_decisions_]

I’ve gotten the feedback a few times about being more thorough with my patients in terms of both asking them HPI questions and their chart.

Sometimes I feel weird asking them questions I should know (it’s already in their chart somewhere) and sometimes I just don’t know what to ask because I don’t know what’s relevant.

I also have a hard time digging through their charts. It’s often times overwhelming and too much information, so I don’t bother.

Any ideas on how to slow down?

[u/FloridlyQuixotic]

If I go into a patient’s room before I’ve had a chance to check a chart (laying eyes on a patient before the discharge if the intern saw them, if something in clinic jumbles the day, etc), and I have to ask them something I’d probably know if I read the chart, I phrase it by saying, “Okay, remind me…”

Seems to work great. Most people can understand reading something and temporarily forgetting. Lands way better than seeming like you haven’t even looked at their chart.

[u/kkmockingbird]

For knowing what to ask for the HPI my favorite tip is to think of your differential for the CC and work backwards from there as to what would distinguish between diagnoses. 

For the rest of it I try to ask the same way every time. If a family is grumbling about “it’s in the chart” I will say something about how I want to check it’s correct or I want to hear the story from them. I will sometimes read off what’s already there like if they have a long med rec (“just wanna make sure we got everything right”). 

[u/FloridlyQuixotic → u/kkmockingbird]

I do that too. I’ll say something like “just to be sure I have it right, …” or “remind me, you’re taking…”

[u/Ill_Advance1406 → u/kkmockingbird]

I'll add in phrases such as "I understand this should be in the chart from your last visit, but sometimes details don't get updated or pieces of information aren't accurately transfered between visits so I like to verify that everything is fully up to date." Essentially, trust but verify

[u/CriticalCaptcha]

With meeting patients, use the phrase “I looked through your chart” - many don’t know until you tell them. “Hi, I read about your history of *** in your chart, but I wanted to make sure nothing got lost in translation, can you tell me more about (whatever you need to find out).”

If you get overwhelmed in a chart, one tip is to look for pathology records, op notes, procedure notes - if it’s important enough to do something invasive or get tissue, you should know about it. Or, hope they’ve had an ID consult recently /s …but not really.

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