Chapter 3 Outpatient Service
How Should I Approach the Outpatient Service?
Your clerkship will likely have about half of its clinical activities in outpatient clinics or physician offices. Your outpatient experiences may range from general pediatrics to subspecialty services. Clinical activities may include health supervision, assessment of common pediatric illnesses, interval visits for patients with chronic conditions, management of children with special healthcare needs, and the diagnosis and management of patients with uncommon diseases and disorders. Each different clinic or outpatient activity may have its own specific approach, so you need to ask about the expectations for your participation. Be prepared, and you will find it easier to fit into the routine. At the medical center, ask a resident or faculty attending about the best way to approach patients. Each community practice will have a specific approach for patient management, so be certain to ask about expectations for your participation. Nurses and other clinic or office staff may be your best resources for practical information. Remember to seek feedback about your skills and knowledge, and then act on the recommendations. In addition, use the clinical problems presented by your patients as triggers for daily learning. The list of key clinical experiences in Chapter 1 can assist you to organize your outpatient rotation.
How Do I Manage Time in the Clinic or Office?
Time represents the most challenging aspect of outpatient rotations, especially in general pediatric clinics and pediatric office practices, because there never seems to be enough of it. Before you enter the examination room, make certain that you have a good understanding of the time allotted for your interaction with the patient. Although you may not have seen the patient before, you are likely to find documentation of the patient’s previous visits to the office or clinic in the medical record. Review of the medical record will provide key information about the patient and family and may help you clarify the presenting complaint. You will need to focus your medical interview and physical examination on the specific problem because of the limited time available. When faced with multiple problems or complaints, you will find it necessary to prioritize and address only those that require immediate attention. This poses the challenge of deciding which problem is the most important, something that you may find difficult. Your ability to manage your time will improve with experience, just as will your ability to prioritize problems and to give efficient case presentations.
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