SOO

Approach to SOOs

Issue #1 (Chief complaint) Issue #2 (revealed after 5 mins, expect a prompt)
  • Onset
  • Palliative/Provocative features
  • Quality
  • Radiation
  • Severity (1-10)
  • Temporal associations (e.g. worsening)
  • Focused ROS
  • F: “You sound very concerned about..”
  • I: “What do you think is going on?”
  • F: “How has this affected your daily activities”
  • E: “What can I help you with this problem..”
  • Same process as Issue #1
  • DON’T FORGET TO FIFE THIS COMPLAINT!!!!
  • Feelings
  • Ideas
  • Functional capacity/changes
  • Expectations*

Ask focused ROS questions to rule-in and rule-out diagnoses on your differential. (often marks on this)

Past Medical History

  • Include Past surgical history (as relevant)

Medications

  • Specifically ask about OTCs and herbals!

Allergies:

  • Clarify reaction if they endorse allergies

 

Social History: FIFERS

  • Family & Friends – Social Supports
    • Marital status/sexual orientation
    • Who they live with?
    • Upbringing
  • Interests & hobbies
  • Finance
  • Employment / Education
    • lifecycle – retirement?
  • Religion
  • Safety, sex, stress
  • Paediatrics: HEADS screen
Family History

  • Relevant risk factors
Substances:

  • EtOH, Smoking, THC, IVDU
  • Addictions: sex/gambling (PRN)

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

  • Bring you back in one week’s time for a complete physical examination
  • Get the old records from your last family physician/ER and review them thoroughly to see what they have said and done
  • Suggest seeing family members or see own family doctor, Group visits (if another person is mentioned in the visit)
  • Order the following blood work:
  • Order the following tests:
  • Refer to specialists/counsellors:
  • Start you on lifestyle modifications and this medication:

 

Plan for issue #2

  • Same as for issue #1, only tailored to the details of their story
  • (that goes for the blood work, investigations, specialist referrals, and medications as well)

Finding Common Ground **

  • Does this sound okay to you?
  • Do you have any questions?

 Strategy:

  • 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

Marks for:

  • 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?
  • Acknowledge/Validate/Support
  • Reassure not his/her fault
  • Confidentiality
  • 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
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CCFP ExamApril 30th, 2015
The big day is here.
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