FAQ: How should I present a patient on rounds?

When presenting a patient on wards

1. Determine who is your audience- medical team? Patient/Family? Tailor your language to fit your
audience
a. For Bedside rounds- no medical jargon, abbreviation or acronyms
b. For medical staff/team: medical language including severity and classifications if needed
2. Determine what content the audience needs to hear.
a. Just Diagnosis and overnight events? Is this an update from the morning? Full H and P?
Abbreviated H and P?
i. This likely will be dictated by your attending and/or your senior resident
ii. Reminder that sometimes the H and P is done by a separate team and the
expectation would have been that the team has read or at least understood the
background.
iii. Important that you lead with either the symptoms or diagnosis, if already
established.
1. If you do not agree with the current working diagnosis, it is okay to lead
with the symptoms, but in your summary should be WHY you like an
alternative diagnosis should be considered
2. If the diagnosis is not known, lead with the presenting symptoms
b. All presentation should have a plan ( comprehensive as possible)
3. Determine the length you have to present
a. Most presentations vary by level of learner
i. For MSIII expect 5 minutes or less
ii. For MSIV expect 3-5 minutes
4. Is there any sensitive information that should be shared outside of family rounds?
a. Any testing of sensitive or protected nature should be mentioned before entry
b. If you are considering malignancy, should be discussed with team before rounds
c. Any protected information (adolescent exam, HEADDSSS) should only be discussed with
permission from the patient.
d. Social work involvement- including custody issues
e. Psychological events that not have previously given permission to discuss openly.
f. If patient is > 18yrs, do you have permission to discuss medical issues with family
members?
5. Consider inclusion of key team members on rounds
a. Respiratory therapist for bronchiolitis or asthma cases ( if needed)
b. Dieticians failure to thrive cases, or other cases that nutritional support would be
helpful ( G tube, TPN, NG feeds, etc)
c. Discharge planning on complex medical conditions
d. Subspecialists ( case by case basis)
6. Have you shared your plan with your residents?
a. As your supervisors, they may have information that you may need to further care
b. Can serve as a “sounding board” for ideas and diff dx
c. You are not in competition- do not hold back information from residents until rounds

E.Taylor MD, Department of Pediatrics , Boonshoft School of Medicine at Wright State University
Adapted from FAQ: “How should I present a ‘new’ patient’s illness at the bedside?” by W.Scott Richardson (January 2008)
11/13/18
Presentation Template (adjust accordingly to your setting)

1. Patient name ( usually first name) – addressed to the patient, if old enough
2. Patient age or gestational (only if applicable)
3. Working Diagnosis or presenting symptoms
4. Pertinent historical data
a. Depending on type of presentation (progress , H and P)
i. If H and P , then
1. illness progress prior to admission
2. Why patient presented to ED
3. Quality, Quantity, Intensity, radiation, chronicity, and degree of
impairment.
4. Aggravating or alleviating factors
5. Associated symptoms
6. Similar problems that happened previously
a. Previous treatments/Previous Workups
b. [Pertinent Past history of other conditions that are of diagnostic, prognostic or pragmatic
significance and would affect the evaluation or treatment of the present illness
c. Family history/Social Hx, if pertinent to the present illness, hospital care or Diff DX
5. Overnight events
a. Include scoring (particularly for asthma or bronchiolitis) ? Oxygen requirement?
i. For bronchiolitis- # of time suctioned and what type of suctioning?
b. Pertinent output or intake
c. Parental concerns
6. Pertinent Physical Findings on your exam
a. Tailor to the working diagnosis
i. If full H and P , may need to be more comprehensive
ii. If progress note , may need to be focused – based on your diagnosis/pertinent + or -
b. If abnormal or unexpected , please state and ask for confirmation from team
i. If not already done with resident before rounds
7. Assessment- What’s is your diagnosis?
8. Plan
a. What planned for today
b. What the team is looking for progression or red flags
i. And what we will do about it
c. Criteria for discharge
1. Expectation/Possibility that discharge may be today or unsure
9. Be prepared to discuss ( likely either outside of room or after rounds)
a. Differential diagnosis
i. Likely not for every patient but if diagnosis is unknown or complex then have at
least two alternative differential diagnoses
b. Further Diagnostic studies
i. Can discussed WHAT you are looking for
ii. Mindful of radiation , nephrotoxic agents and age of patient
c. Counseling
i. What to say, references to use , and HOW you would say it
d. Contingency Plan if the patient doesn’t respond to treatment
E.Taylor MD, Department of Pediatrics , Boonshoft School of Medicine at Wright State University
Adapted from FAQ: “How should I present a ‘new’ patient’s illness at the bedside?” by W.Scott Richardson (January 2008)
11/13/18