An Approach to the Day in Your Family Practice

1. Review the common problems list prior to arrival.

2. Arrive early.

3. Review the patient schedule with your preceptor and identify:

   1. Patients that might provide a good learning experience to address a common problem.

   2. Patients that your preceptor would prefer that you not see.

4. Scan the patient's chart.

   1. Problem list

   2. Medications

      1. Review the list of all medications.

   3. Chronic illnesses

      1. Disease surveillance needs

      2. Medications

      3. Outstanding issues

   4. Preventive services

      1. Patient centered prevention needs

         1. Primary

         2. Secondary

      2. Tertiary preventions needs (example:  beta-blocker in patient with prior MI)

         1. Chronic disease management (see 4c)

   5. Any activity since last office visit

      1. Outstanding labs

      2. Referrals/consultation reports

5. Discuss any specific focus that the preceptor wishes to have addressed by you during the visit.

6. When patient arrives

   1. Introduce yourself

   2. Evaluate the patient based on your discussion with the preceptor re: your responsibilities

   3. Review and update the medication list.

   4. Present the patient to your preceptor.

      1. Focused

      2. Brief

      3. Well organized...SOAP format

      4. Review the components of item 4 as the preceptor allows

         1. Take notes on the items even if you do not present them

         2. Provide a copy of your review to your preceptor as they may use them to update the patient's history.

      5. Write a SOAP note on at least 1-2 patients per day.

         1. Give a copy to the preceptor...even if it does not appear in the record...for review

         2. Save 2 for the final submission...without personal health information

7. Thank the patient.

8. Read about the patient's main problem or chronic disease.

9. Enter the patient in your disease registry if they have a chronic illness...even if that was not the main focus of the visit.