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Based on advice from Dr Hashmi (a super cool and friendly GP) who passed his CSA in 2015.
After taking the Hx, finding their concern and examining…do the Hashmi hat-trick all in one go without letting the patient speak!
Example 1
Part 1: ‘I know you came in today, because you were worried the swelling you had in your leg, might be an infection…’
Part 2: ‘…After listening to your story and examining you, I don’t think it’s an infection, but unfortunately I think it might be something more serious, like a blood clot…’
Part 3: ‘…and I want to send an urgent referral straight away to a clinic, who will contact you today, to investigate if there is a clot there or not’.
The examiner sitting in the corner now knows that you will not miss a DVT. That you are safe. And will pass you.
You addressed the patients concerns, made a differential, and a safe plan.
If you missed anything in the Hx they will tell you now, so don’t worry about getting every last bit of information, otherwise you will run out of time e.g. the patient might reply to the above with…’But doctor what about Fluffy, my cat. Who’s going to look after her?’
Example 2
‘I know you came in today because you wanted an MRI scan for your back…’
‘…From the things you’ve told me and after having examined you, it actually looks like you’ve got something we see quite commonly called mechanical back pain, and MRI scans dont usually help patients…’
‘…What we do find helps is x, y, z’.
Example 3
‘I know you came in today to see if there were any eye drops that might help your vision, which has got worse the last few months…’
‘…After listening to your story and after examining you, I actually think you may have cataracts…’
‘…and I am going to send an urgent referral to the eye doctors to ask them to have a look at your eyes. Its also important that you dont drive, because your vision is so poor you might crash and hurt your self or others on the road.’