Prioritizing chief complaints and not missing anything

kanzi monkey · Apr 7, 2009

As I complete my final month of clinicals, I find myself trying to explore those nagging insecurities that infuse me with this vague fear...

Yesterday I was trying to figure out why I find myself needing my preceptor so much--why I feel that I would be unable to manage a patient without her, and this is what I came up with: most of the patients I see have multiple complaints. Depending on the patient's way of describing what it is that's bothering them (I have a lot of non-english speaking patients coming from very different cultural backgrounds, or homeless patients with a very different level of education) I find myself trying to not only understand the gist of their complaints, but trying to frame what they are saying in a physical model that I can understand (ie, I had a pt who insisted that she had "meat" come out of her rectum--her initial complaint is of knee pain, and she's in her 60s and never had pelvic exam. She's here for a physical, and technically I have 20 minutes, though it takes me 40 just to illicit this information. Another pt who has frequent unprotected sex [never uses BC], multiple abortions, and no desire to get pregnant--she has been spotting daily for over a month, doesn't remember the last time she had a normal period. Is at the clinic for CC of back pain and routine PE--is totally shocked that we should do a pregnancy test, but also more concerned about her back)

I've heard a lot of providers talk about ways they set limits with patients regarding what issues they address at this visit. I can't wait until I feel comfortable with this, because my visits take so long at the moment. My question for those of you who have a little more experience--how are you able to set these limits and feel confident that you aren't going to miss something by not getting the full history of each CC?

-Kan