Artifact: ATEM Assessment
I am currently applying for my emergency medicine residency, and as such am enrolled in the Advanced Topics in Emergency Medicine course at OSU. This course has many components to prepare us for our residency, one of which is assessment shifts conducted periodically throughout our 4th year. We essentially are paired with one emergency medicine physician and will evaluate a patient in the ED from start to finish, while they oversee the encounter and provide feedback.
On my most recent shift, I picked up a patient with an elevated glucose >500 who was otherwise asymptomatic. My instructor insisted I go in “blind” as a learning experience, not having looked at previous notes for the patient. I’ve had multiple EM docs push me to try this, and I’ve come to understand that it can improve patient care by teaching you not to narrow down on a single diagnosis. When you read a patient’s chart, it’s easy to reason through it and hone in on a couple of pathologies, but you may not have the full story and this habit may cause you to forget other items on the differential. I conducted the visit, with a focus on eliciting a HOPI. This was the first patient I had seen in several months due to interviews, and I definitely felt a little rusty on my history taking. However, I felt that I had taken a pretty good focused history, making sure none of the patient’s symptoms pointed to anything dangerous.
Afterwards, me and the physician I was paired with sat down and had a discussion about the encounter. He said I did a great job taking a focused history, ruling out some of the most dangerous diagnoses. One comment is that I forgot to perform a complete review of systems, instead having only focused on the chief complaint and possibly related pathologies. The biggest point of feedback, however, was on how I established a relationship with the patient. In my student experience in the emergency department, I always felt pressured to conduct a history as quickly and accurately as possible. While I was always polite with patients, I don’t think I really went out of my away enough to build a relationship with them. The physician I was working with expounded on the benefits of this practice. He told me that patients will open up to you more if you build that trust. He also said it can help with compliance, and overall patients will have a better experience. While this all made sense to me and I had heard it before, I never had someone sit down with me and run through exactly how to do this. I’ve always been focused on the strictly medical side of patient interactions as a student, trying to hone these skills. I’ve started to realize that as I progress in my training, I should be expanding my training beyond the basic concepts of physiology and pathology. This assessment shift strongly reinforced the important social factors of patient care, and it’s something I’ve since committed to improving upon.
I found a great paper with a list of priorities for building rapport with new patients1, which is almost every patient I’ll see in the emergency department. Here are the big items from that paper:
- Provide reassurance to patients
- Tell patients it’s okay to ask questions
- Show patients their lab results and explain what they mean
- Avoid language and behaviors that are judgmental of patients
- Ask patients what they want [i.e., treatment goals and preferences]
I hope to apply all these concepts as best I can with each visit going forward in my training and beyond!
- Dang BN, Westbrook RA, Njue SM, Giordano TP. Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study. BMC Med Educ. 2017;17(1):32. Published 2017 Feb 2. doi:10.1186/s12909-017-0868-5