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Identify What Is Solvable
Published in Scott A. Simpson, Anna K. McDowell, The Clinical Interview, 2019
Scott A. Simpson, Anna K. McDowell
Elicit the patient’s chief complaint and make note of all concerns. Review with the patient their self-identified needs to validate their concerns and build the treatment alliance. Then focus with the patient on which complaints are addressable, or solvable, in the current appointment. “Which of these issues should we focus on solving today?” Reassure the patient that you understand they have many concerns and, at the same time, you will together make the most of the present encounter by addressing what is solvable.
The Alliance
Published in Brown Judith Belle, Challenges and Solutions: Narratives of Patient-Centered Care, 2017
That Friday night, Dr. Johnston was starting her third back-to-back night shift. As she trudged over to the nursing desk, already fatigued, the nurse slapped a chart in her hand, “Good luck with this frequent flyer,„ she smirked. Dr. Johnston never liked that term – frequent flyer. Although it simply referred to someone who repeatedly returned seeking care from the ER, it conveyed a negative, attention-seeking undertone. Dr. Johnston looked down at the chief complaint, printed in caps at the top of the chart: CHEST PAIN.
Metaphors in medical education
Published in Alan Bleakley, Thinking with Metaphors in Medicine, 2017
Illness scripts are hypothesized (and hypostatized) cognitive maps that are clusters of facts based around remembering groups of patients presenting with certain symptoms. Such scripts contain little pathophysiological data, but lots of clinically relevant material. Once the ‘chief complaint’ is identified, the doctor searches unconsciously for recognition of an encoded illness script that matches the symptoms. ‘Chief complaint’ is a medically centred metaphor for symptom presentation and can be reconfigured as another metaphor, the patient’s ‘chief concern’ (Schleifer and Vannatta 2013). Indeed, the potential mismatch between the metaphors of the chief complaint and the chief concern is a source of rhetorical conflict in the doctor–patient interaction. Further, the chief complaint is referred to as a ‘pathophysiologic insult’ – a metaphor for major or minor injury or infection (viral ‘invasion’ – another war metaphor, local inflammation, perforation and so forth).
Implementation of three knowledge-oriented instructional strategies to teach clinical reasoning: Self-explanation, a concept mapping exercise, and deliberate reflection: AMEE Guide No. 150
Published in Medical Teacher, 2023
Dario Torre, Martine Chamberland, Silvia Mamede
The case presentation purposefully entails only the chief complaint of a patient. For example, a 55-year-old male patient presenting with acute chest pain.The map content is displayed visually as a preconstructed set of nodes with key information about the diseases that all present with the same chief complaint (acute chest pain).The learner needs to provide a diagnosis consistent with a series of accurate connections among the nodes containing parts of the script, by completing the empty nodes at the bottom of the exercise.Since there is no complete clinical case-to-be-solved, there is not a single best answer but the accurate identification and connections of prototypical components of three to five disease entities that may constitute a differential diagnosis for the patient’s chief complaint. Instructor Steps in the design of the CREsME technique are provided in Table 2.
Advanced Life Support for Out-of-Hospital Chest Pain: The OPALS Study†
Published in Prehospital Emergency Care, 2022
Ian G. Stiell, Justin Maloney, Jon Dreyer, Doug Munkley, Daniel W. Spaite, Marion B. Lyver, Julie E. Sinclair, George A. Wells
The study population included all persons 16 years of age or older, who presented primarily with chest pain and who were transported by ambulance with return codes “3” (prompt) or “4” (urgent). This included all patients whose chief complaint was acute (< 2 days) chest pain, regardless of shortness of breath). Patients were also included if their primary complaint was pain in the arm(s), neck, or jaw if this was consistent with myocardial ischemia. Excluded were people younger than 16 years of age, persons in full cardiac arrest upon EMS arrival, persons who presented with palpitations or epigastric pain, persons suffering primarily from respiratory distress, and trauma victims. The same patient selection processes were used for both phases of the study. The study received full approval by The Ottawa Hospital Research Ethics Board and the requirement for informed consent was waived.
Feasibility of right coronary artery first ergonovine provocation test
Published in Acta Cardiologica, 2021
Hyun Seok Ham, Ki-Hun Kim, Jino Park, Yeo-Jeong Song, Seunghwan Kim, Dong-Kie Kim, Sang-Hoon Seol, Doo-Il Kim
From October 2010 to October 2017, we reviewed all cases of patients who underwent the IC ergonovine provocation test in our centre. Total of 801 patients underwent the IC ergonovine provocation test for suspected coronary spasm, and we selected 725 patients. Seventy-two patients were excluded from the study because of a previously inserted coronary artery stent (42 cases), significant coronary artery stenosis (23 cases), insufficient medical records (10 cases), and history of nitroglycerine use (1 case). Informed consent for the IC ergonovine provocation test was obtained from each patient, and the study was reviewed and approved by the institutional review board of Inje University. The patients’ baseline clinical characteristics are listed in Table 1. The mean age was 58.5 ± 11.9 years, and there were 402 males patients (55.4%). The mean left ventricular ejection fraction was 63.7 ± 4.8%, and the mean left atrium diameter was 35.8 ± 4.5 mm. Chest pain (644 patients, 88.8%) was the most common chief complaint followed by dyspnoea (26 patients, 3.6%), syncope (26 patients, 3.6%), sudden cardiac arrest (22 patients, 3.0%), palpitation (5 patients, 0.7%), and no symptom (2 patients, 0.3%). The ergonovine positive results were observed in chest pain (241/644 patients, 37.4%), dyspnoea (11/26 patients, 42.3%), syncope (8/26 patients, 30.8%), sudden cardiac arrest (8/22 patients, 36.4%), palpitation (1/5 patients, 20.0%), and no symptom (0/2 patients, 0.0%) groups.