USMLE study report 2

case 2 FA 21 year old female come to ER with abdominal pain

point1 : Counselling in ER situation
It's not appropriate to use ask,address,advise,assist bla bla.. in time that patient have severe pain. So just
I would like to talk to you later about sexual practice and smoking.

point 2: Tense & Sense
If patient say: I smoked last year = Last year she smoke only once
If patient say: I used to smoke last year = Last year she smoke regualry
If patient say: I have smoked since last year= She emphasize that today she still smoke.
note: ever only use in question sentence.Therefore patient will not say : I ever smoke
but...
If doctor ask: did you smoke = Please recall recently
If doctor ask: Have you smoked in past year = Please recall through last year
If doctor ask: Have you ever smoked = Please recall through life !!

point 3: To - For-On
check for
listen to
press on / thumb on

point4: Sensitive question
Excuse me, but I need to ask..
How many sexual partners have you had in past year

point 5: aware word " Quit it" - "Stop it" which are too command
prefer using "stop smoking" or "Stop smoking"

point6: Again! always asking permission for examination before washing hand
eg. Next,I would like to do a physical exam - is that OK with you....

point7: Precipitating factor
What were you doing when the pain starte - for physical symptom
Did anything change in your life before you have this problem - for psychological symptom