Simple Rules - Dr. Fox

The BounceBack Patient
The "BounceBack" Patient offers use an opportunity... to either be as foolish as we were before or to make up for previous mistakes.

With all patient encounters (whether 1st encounter, 2nd encounter, or 102nd encounter) keep these simple rules in mind:

• History is Job #1
  OLDCAAR
  Spending a little more time up front on a good history will save you a lot of time later. 
  Your medical decision making is built upon the foundation of your hisotry and physical.  Make sure you have a strong foundation to build upon.
  
  
  • "When you hear hoofbeats... think Lions,Tigers, and Bears"
    This is a phrase shamelessly stolen from one of my mentors, Dr. Mattu... but it runs through my head constantly.
    Most of the conditions that we evaluate (gastroenteritis, viral syndromes) are able to be accurately diagnosed and managed by grandmothers.  You, however, are not paid to be a grandma.  You are paid to ensure you don't miss the Liond, Tigers, or Bears that are following the poor unsuspecting horse.
    In short, always think "worse first."
    
    
    • Chart Discrepencies - FIX THEM!
      In the view of the court, the EMS history carries the same weight as the RN history which is equal to yours.
      Make sure that you read all of the chart to ensure that you are not missing a key point.
      If there is a discrepancy, go ask the patient directly about it.  Your history taken twice and clarified outweighs all others.
      
      
      • Always address all complaints.
        This can be tough... yes... I have been there too.  But do a thorough H+P and you will likely be able to address many of the additional complaints without much more effort.  But ignore them at your own peril.
        
        
        • Read your own Words!
          This is critical... particularly if you are using a dictation system or Dragon. 
          Step back and ask if they picture you are painting is consistent with the plan you are constructed.
          Also, significant typos can be construed (by a lawyer) as an imprecise and inaccurate physician.
          

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