10 minute read
Say what matters, in order
The reliable skeleton: one-liner (who and why they are here), overnight events, focused data (vitals trends, pertinent exam, new results only), then assessment and plan by problem. Thirty seconds of signal beats five minutes of chart reading aloud.
The one-liner is your problem representation said aloud. If the team can predict your plan from your one-liner, the presentation is working.
The skeleton, line by line
One-liner: name, age, day of admission, working diagnosis, trajectory in one word ('day 3 of pneumonia, improving'). Overnight: only events that demanded a decision or change nothing at all ('quiet night' is a complete sentence). Vitals: as trends against yesterday, leading with the abnormal one. Exam: the two or three findings that track the problem, not the full head-to-toe. Data: new results only, each attached to the question it answers. Assessment and plan: by problem, each problem getting a status, a reasoning clause, and a plan with a reassessment built in. Close with the discharge blocker.
Notice what the skeleton excludes: the admission story retold (the team was there), normal results without a question attached, and the medication list read aloud. Everything you say should either update the team's model of the patient or set up a decision.
A presentation, annotated
'Mrs. Osei, 71, day 2 of a COPD exacerbation, better. Overnight: one salbutamol at 02:00, settled. She is off oxygen since 06:00 with saturations 93 to 94 on air, down from 2 litres yesterday. Chest has scattered wheeze, much less than admission. Gas this morning shows the CO2 back at her baseline of 52. COPD: improving on steroids day 2 of 5, stepping nebulizers to inhalers today. Diabetes: sugars ran 12 to 14 on the sliding scale, restarting metformin with breakfast. Discharge blocker: she needs inhaler technique review and a home supply; aiming for tomorrow.' Under forty seconds, and every sentence carries either a trend or a decision.
Anticipate the questions
Rounds questions are predictable: what changed, why is the plan the plan, what is blocking discharge, and what are we watching for. Building the answers into the presentation is what 'sounding senior' actually is.
When a question lands anyway, answer it in the same shape: the datum, the trend, what you make of it. 'I do not know, but I will find out by noon and it changes whether we scan' is a strong answer; improvising a number is the only weak one.
Adjust to the audience
The skeleton flexes by listener. The attending on rounds gets the version above. A consultant being phoned gets the question first ('I am calling about possible urgent scope'), then the one-liner, then only the data that bears on their decision. A night colleague gets the handover form: sick-or-not, watch-fors, if-thens. The family gets plain words, trajectory, and what happens next, with the jargon translated rather than repeated louder. Same case, four different presentations, one underlying representation.
Pearls
- Trend, not value: present the creatinine as a slope.
- End every patient with the discharge blocker named.
- 'Quiet night' is a complete sentence; padding it erodes trust in everything else you say.
- If the one-liner predicts the plan, the presentation is working; if not, fix the one-liner first.
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