Selling the Story I

There is an interesting phenomenon with oral presentations. When we first start out as medical students - clear as the morning sky - we present all the information in an unbiased fashion. If we are good medical students, our histories are the telephone book; we have drawn out a family forest, we know the names of their pets, we can trace the history of their symptoms to the minute. But then our presentations become discombobulated and muddled. There's too much going on. What's important? What's not? As a medical student, we hope someone else will do the interpreting, that someone else will funnel that information into a pristine and obvious diagnosis.

But then we learn a very counter-intuitive convention and practice. When we present our patients, we should paint the story of the diagnosis we want listeners to conclude. We intend to bias them with the information we present. The great attendings and residents are able to see beyond the obvious and catch any mis-diagnoses, but we should still present the story as if there were one leading candidate. Since medical school, this approach seems more and more obvious. The person who collects all the information should attempt to interpret it; if they do not, the information is less helpful because it is a big mess. But then, your story is only as good as the first report, and how they sell the story can change everything. Some examples tomorrow.