Vol. 33, No. 1 Winter 2010
Clerkships and clinic visits
All medical students at the UW School of Medicine are required to participate in the third-year family medicine clerkship. It’s a six-week program in which students are placed throughout the five-state region of WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) to experience family medicine firsthand. Next year, the program will place between 220 to 230 students.
Tom Greer, Jr., MPH ’79, professor of family medicine, director of medical student programs and co-director of TRUST, is the co-director of the clerkship. When he visits clerkship sites, he assesses the site’s needs, shares student evaluations and fields questions from preceptors.
On these visits, Greer also shares a checklist developed by Larry B. Mauksch, a senior lecturer at UW Medicine and a nationally recognized authority in patient-centered care and communications. It’s a useful tool for preceptors and the students they’re teaching, especially practitioners who see many patients each day. It also benefits patients. Below is a truncated version of the checklist.
Did you introduce yourself to everyone in the room?
Did you build rapport with the patient?
Greer notes that this needn’t take long; it can be a 30- to 60-second chat about sports, school, the weather, etc.
Did you set an agenda?
Some people come to a doctor’s appointment with a list of three, five or seven things to talk about, says Greer. If the patient didn’t arrange a special appointment with the doctor’s office ahead of time, the appointment may not be long enough to accommodate all the issues. Alternately, clinic visits can take an unexpected direction. A patient may present with a cold, then inform the doctor that he’s depressed and needs to talk. Doctors should ask the patient to list the things they’d like to talk about and to rank them in importance. Then the doctor and the patient can focus on the important issues and set realistic expectations for what can be accomplished in one visit.
Did you listen to the patient’s history and perspective of illness?
A good question to ask, says Greer, is “What do you think is causing your symptoms? What were you hoping I would do today?”
Did you and the patient reach common ground?
Summarize the visit in a way that involves the patient, Greer says. “Here’s what’s going on; here’s what I recommend. Does this sound reasonable to you?”
Did you give the patient a printed summary?
At the UW, says Greer, the electronic records system allows doctors to print out the information shared during the appointment and to list the steps being taken for follow-up care. The patient is given this easy-to-read summary, complete with information on tests ordered and medication prescribed. There are no “maddening” lists or codes, says Greer. “It’s pretty cool.”
Find the full checklist on the Department of Family Medicine website. After you access the site, click on “downloads,” then click on “POVE feedback form.”
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