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My 93-year-old grandmother had a successful knee surgery on Monday. Two pins and some keen wiring closed a two-inch gap on her broken right kneecap. 

I had a chance to spend time with her today at Methodist Hospital. Lying in bed with a new bionic leg brace, she clutched a stuffed toy dog, named “Propwash,” that my grandfather had given her during his military service in World War II with the U.S. Army Air Corps in Europe, where he helped build communication systems to land British bombers.

According to my mother, anytime the children were sick, my grandmother would give them Prowash to have in their beds. The grandchildren received similar comfort when we stayed at our grandparent’s home.

The first image in this pair of photos was made this afternoon, Jan. 31. The second image was made the night before her surgery, Jan. 29, as she rested in my grandfather’s lift chair. My uncle, who’s been at her bedside for much of the past week, appears in the background of the first image.

Many thanks to all my tumblr friends who’ve expressed their concern, love and support after I shared images from my grandmother’s initial ER visit last weekend. It’s meant the world to me and to my family. 

~Michael

Patient Presentations Part I - Organization is Key

One thing I have struggled with during my clinical years is the patient presentation.  Sometimes I am told I include too much information, sometimes not enough.  After tons of feedback, advice from residents/fellows, and much trial and error I have come up with a method that seems to work well for patient me.  Obviously you can’t please everyone, but I find that this is a good starting point.  I wanted to share my method with all of you who may also struggle with presenting patients.

There are three components to my system: the SOAP format, creating single statements for each component of your presentation, and writing down more thorough data incase you are asked. So what does that look like? Well, like this:

Each morning I print out a rounding report, then fold it over and organize my presentation.  This also helps me organize my thoughts and has made me a better student clinician.  

At the top of each page I write a summary statement, in the format of:

 Age + Ethnicity + Gender + Past Medical History + Admit Date + Chief Concern and/or Diagnosis

Starting with a statement like this helps to orient the team and I to the patient.  You should only include the past medical history and risk factors that pertain to the current problem (we don’t need to know that there is a history of toe fungus or a tonsillectomy when the patient was 7, unless, of course, it is pertinent to the current problem).  When presenting, you can connect the above information into a quick patient summary.  Examples might include:

- This is Mr. Smith, a 48 y.o. WM w/PMH of CML and alcohol dependence who was admitted on the 17th with progressive abdominal pain

- This is Mrs. Jones, a 32 y.o. AAW w/PMH of sarcoidosis who presented for symptomatic bradycardia

- This is Mr. Johnson, a 69 y.o. Native American male w/PMH of CAD s/p CABG in 2003, HTN, HLD, DMII and a 40 pack year smoking history who presented for unstable angina

So that is starting the presentation.  See the next 4 parts for the rest.