Approach to SOOs
|Issue #1 (Chief complaint)||Issue #2 (revealed after 5 mins, expect a prompt)|
Ask focused ROS questions to rule-in and rule-out diagnoses on your differential. (often marks on this)
|Past Medical History
|Social History: FIFERS
Notification at 3 minute mark- Integration
Connect social situation to the medical complaints:
At this point in the encounter I would like to take a moment to summarize what is going on. You came in with issue #1, and it sounds to me like ‘this’ is happening. At the same time, I recognize that you have this issue #2 in your life right now, which may be impacting on your first issue, and adding undue stress at the moment. What I would like to do is the following
|Plan for issue #1
|Plan for issue #2
Finding Common Ground **
- If they have not cued you for the second issue yet, start picking away at the PMHx, PMH, Meds, Allergies, SHx, and FHx. Get as far as you can in this category.
- Once you believe you know the second issue, explore it much like the first. Don’t forget to FIFE!
- Once notified of 3 mins remaining, stop gathering information and start summarizing.
- Make a integrated statement mentioning the two issues and a component of the FIFE history to make an empathetic statement about their functioning/expectations.
- Mention your plan for issues #1 and #2 and be as specific as you can
How to ACE the SOOs
- History and Illness Experience Problem #1/#2 (3 min/3 min)
- Context Identification and Integration (2.5 min/30sec)
- Plan + Finding Common Ground Problem #1/#2 (30 sec/2.5 min and 30 sec/2.5min)
- Interview Process + Organization
Plan: Establish diagnosis
- Explain prognosis/natural history- Is illness common?
- Reassure not his/her fault
- Discuss drug plan, health plan, disability
- Treatment – Pharmacologic/ Non Pharmacologic
- GIVE LIKELY DIAGNOSIS AND OTHER POSSIBILITIES
- When to F/U – red flags. SUGGEST F/U VISIT