Clinical Guide The Nerd's Guide to Pre-Rounding Table of Contents Part 8. Presentations: "Here There Be Dragons" When you give a specially-prepared presentation on a patient, here’s a warning: The presentation may not be on the subject you think it is. Both I and a classmate had experiences of preparing talks on special subjects related to our patients—in my case, various methods for imaging metastases in colon cancer patients; in his case, drugs for treating PCP. Both of us were horrified to find ourselves shanghaied by attendings who pimped us on aspects of the case we weren’t prepared to talk about. In my own case, the attending stopped me in the middle of my talk and started pimping me about atrial fibrillation—a cardiac problem that had emerged as a post-surgical complication, but had nothing to do with his reason for surgery. I confess, at that moment I recalled almost zero about a-fib, other than that it was an arrhythmia often seen in old folks that was often tolerated just fine with treatment. That’s it. That’s all I knew. I didn’t even know the EKG pattern associated with it. Well, needless to say, I started feeling like I was getting a-fib by the time my attending had asked her fifth or sixth cardiac-related question. Finally she stopped, looked at me, and said, "Didn’t you learn anything in medical school?" (sigh… again, unnecessarily deflating treatment from a superior officer: uncivilized, but unsurprising. See "The Horrible Truth About the Wards," below.) How to deal with this? Know the basics on every item in your patient’s problem list, not just their main diagnosis. Also know the basics on all of their drugs—including the rationale for using them in your patient. This way, if your attending turns your presentation into a "hostile interview," you won’t look completely lost. Oh, another warning about presentations: You may slave away on an assigned talk, only to find the attending has totally forgotten about it, or there isn’t time to present it at the scheduled time. This happens very often, more than the above scenario. Of course, you have to be ready to present it, because often, just as soon as you’ve totally forgotten about it, your chief will say, "Hey, weren’t you going to give us a talk on ...? Why don’t you give it to us now?" Remember that it’s okay to assertively remind your team or attending if you have a presentation that’s overdue. If the time passes and you’ve shown due diligence, but there simply wasn’t time for you to present, well… chalk it up as a learning experience. Save the handouts—you may get a chance to give the talk to a different group, at a later date.