When to Counsel

Step 2 CS exam offers very limited time for patient encounter. Planning every thing precisely before hand is extremely important.

Counseling can be done either during or the encounter or at the end.


Counseling in the End

Most of the issues requiring counseling arise during and after PMH (past medical history). For example smoking, alcohol abuse, unsafe sexual practices. Counseling for these issues can be done at the end of the case ie after the physical examinatoin.

Advantages:

1)You dont need to interrupt your history taking pattern to cousel on any specific issue. So no risk of fortetting you next question.

2) Saves time

3) You can address all issues together wihtout need to counsell again and again.

Disadvantages:

1)Certain issues require immediate counseling, like a patient in severe pain asking for pain medication, mute psychiatric patinet, abuse patinent to calm her and to make her trust you.

2) If a particular case has more than one issues, you may forget one of those if you dont write it down on your sheet.

3) There is risk of running out of time when the case is ending and obvioiusly you dont want to miss this imprtant component.


Counseling during the encounter (as per needed)

You can cousel the patinet any time during the encounter, ie before or during HPI (history of presenting illness), during PMH (past medical history), during Physical exam (rarely but if patient asks you some quesition) and during the closing of the case ie after the physical exam.

Advantages:

1)Every issue can be addressed there and then.

2) No need to remeber or write notes.

3) No hassle of doing a lot of things while closing the encounter.

Disadvantages:

1)You have to break your flow, and there is risk of forgetting your next question

2)Takes more time.

Which one to use:

Its your personnel choice. The first pattern is not bad, provided that you addres the immediate issues there and then.

I chose the second one, because I didnt want to keep a lot of things in the end. I also thought that I might miss and forget some important issue. Regarding the time and flow disadvantage, I think keeping you sentences short and doing a lot of practice can overcome that.