Overall protocal

Finally, I try to summarized from many sources..First Aids book, Neeraj's note, Prep4USMLE
This exam seem to be test in major two aspects
1. To satisfy rater patient : Communication skill ...weighted 70%
2. To satisfy rater physician : Medical record ....weighted 30%

There are three parts for communication skill

1 Information taking skill
2 Information sharing skill
3. Nonverbal " Good bed side manner"

1. Information taking skill
Aim is effective interview.Able to encourage patient give information without embarrassing
- Open ended question
- Address patient idea
- Address patient sign
- Paraphrasing
- Use transition phrase
- Summarize

2. Information sharing skill
Aim is appropriate response to patient reaction. Diplomatic yet polite manner.

3. Nonverbal manner
- Smile
- Drape
- Empathy expression

From those three concepts let me make protocol as following

Opening encounter
Someone from prep4usmle suggest "The all 10 become by practice"
1 KNOCK KNOCK (Recall patient name before knocking) ---- Enter SMILING
2. Ms/Mr......... - I am Dr............ (first patient name then your name) .
3. Shake hands and Eye contact with patient (2 & 3 are done together)
4. SIT DOWN on the Stool (May I take a seat and take some note while we are talking)
DRAPE (as you say "I would like to make you more comfortable") -
5 Open question (How can I help you today) - Empathy expression ( eg.I see you are in pain)

Between encounter
Present illness

Next, I would like to ask about your general medical condition.( Transition )
Past history : PAM HUG

I'm going to ask you some personal question, is that OK for you? ( Transition )
FOS ( SODA )
" To make sure I've understand your problem correctly ; you have......................, is this correct
( Summarize)

OK - Next I would like to do some physical exam,is that OK with you.
...I want to wash my hand for a minute-
...." What type of work do you do..."
...." How is this problem affect your life?"

Physical exam:
First I would like to check your eyes....
I would like to check your heart and lungs..May I untie your gown...
---well done---I will retie the gown for you.
Focus system eg. JVC,Abdomen,Neuro

Close encounter
Thank you for your cooperation.Mr X.
From the information you gave me and the physical exams.
There are some possible cause of your problem.
You may have ( Impression).....or.........
So I would like to run some test,including rectal(Vg/breast) exam,blood test(urine test,pregnacy test0,and possibly CT scan(X-ray/ultrasound) of your abdomen (Investigation)
Is that OK with you?

OK,Mr. Smith,as a concerned physician, you need to quit smoking.
We have a smoking cessation clinic here at the hospital that can help you quit
smoking (Giving Counselling)

Do you have any question or concern?
..After all the lab results come, I will discuss with you more in details.

Throughout encounter
appropriate paraphrasing for important patient's answer *BUT Don't repeat question!!
approprate respons for challanging patient's question
.......

By the conclusion, there are 8 critical steps to do in every case
1. Introduction
2.Drape
3.History taking
4.Wash hand
5.Physical exam
6.Inform (Diagnosis+Investigation)
7.Counseling
8.Any question or concern