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Taking notes and presenting
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Taking notes and presenting

Most people jott down some notes during history taking. The chief purpose is to organise your thoughts during the history, and as an aid during presentation. Presentation is a skill that is often learnt essentially through humiliation: you have spent an hour on a patient and when you come to report your findings your listener rudely interrupts you and tells you not to report something that you have found! 

When you present a case you should do it with a diagnosis in mind, so everything you say should either support that diagnosis or help in ruling out other diseases. It is often repeated that you should "present all the positive findings, and all the relevant negatives." That little word, "relevant," masks that you need to be experienced in history taking to know what is relevant.

We suggest that if you are having trouble structuring your history when you take it (you forget to ask some important questions), or if especially you can not structure your presentation you might try using the mind-map technique for taking notes. An example is given below:

mindmap image
The mindmap technique

The diagram is quite self-explanatory. Jott down the patients details in the middle of the page. Write PC, HPC, Differential, and Risk Factors in the four quadrants. Once you think you have completed these components of the history turn the page over and do the rest, which are usually quite routine. This method makes it easy to come back and fill in the blanks, for example if you can't recall all the risk factors for lung cancer (quite likely) then whenever you remember one come back and fill it in.

It is most useful for presentation. You can reel off a tight summary immediately: "This is Miss Hilton, a 43 year old lady admitted as an emergency 5 days ago. Her presenting complaint was shortness of breath which she had experienced gradually coming on over 10 days, it occurs especially on exertion. This is accompanied by fever..."

It is not for everybody but it may be worth a try. A colleague of ours having trouble with his presenting picked it up 4 days before his exam and passed successfully.

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