Investigations

After your examination/ history, the examiner will expect you to present what you wish to do next, ie other examinations or histories, basic observations, and then investigations. . I recommend presenting the investigations you want to undertake for a patient in a structured and organised way. This is valid for an OSCE setting and also of course in the hospital setting when talking to a senior.

Having a structure to follow is super useful to make sure you don’t forget anything and also to show you are organised and taking things step by step.

Here are the steps I suggest: 1️⃣ Bedside 🛏 (basic observations (HR, RR, BP, temperature), ECG, urine dip…) 2️⃣ Lab tests 🧪 (blood tests: say which specific ones and explain WHY! other: stool…) 3️⃣ Imaging 📷 (which type of imaging and why: x-ray, ultrasound, CT…) 4️⃣ Special tests ✨ (angiogram, spirometry…)

As you can see it goes from the simplest, less specialised and less invasive to the more complicated, specialist and invasive tests. This is how we should always be thinking so it shows the examiner you are thinking in a logical way!

Management

After you examination/ history and you suggest your investigations, the examiner may give you examination results and ask you what management you would put in place for the patient.

Again having this structure to follow is super useful to make sure you don’t forget anything and also to show you are organised and taking things step by step.

Here are the steps I suggest, for chronic conditions: 1️⃣ Conservative 🌱 (These include simply monitoring but also lifestyle changes as well like stopping smoking, improving diet, exercising…) 2️⃣ Medical (This means medications you can offer, some for purely symptom relief others to stop the disease) 3️⃣ Surgical 🔪 (This includes interventional radiology, less invasive surgeries all the way to heavy surgeries)

Here are the steps I suggest for acute conditions:

1️⃣ A to E approach + Call for help if it is an emergency

2️⃣ Stabilising the patient + pain relief, this is so important!

3️⃣ Curative step: emergency medications or surgery

For psychiatry: always say you will use a Biopsychosocial approach, and use this as a structure: