8-10
SAMPLE CHECKLIST FOR EVALUATING A CONSULTATION
Note: This self-evaluation checklist
is a sample, intended for raising
questions as well as for evaluation.
You do not have to read it in detail
as you read through this chapter.
Refer to it later if you need to.
PERSONAL APPROACH AND ATTITUDE-
Did you . ..
——attend the person promptly? Or did he have to
wail long?
——spot at once if the person was very sick, and if
so. see him ahead of others?
——invite the mother or relative to take part in the
consultation (if appropriate)?
——ask the sick person and family members to sit
down, and make them feel at ease?
——sit close to them, not behind a desk or table?
——ask questions and take the time to listen to
personal and family concerns? Were you really
interested in the patient as a person?
——touch children and show warmth?
MEDICAL HISTORY
——Observation: Did you look for and see obvious
signs of illness early in the consultation?
For example:
• general appearance and health (weight,
posture, relaxed, nervous, depressed, etc.)
• skin color (normal, pale, yellow, blue)
• eyes (color of whiles, pupil size, etc.)
• breathing {sounds, rate, effort, sucking in of
skin behind collar bone)
• bulging veins, sea’s, sores
• specific signs of illness
History (questioning the sick person): Did you ...
——Take an adequate history before starting the
physical examination?
——ask appropriate questions in a sensible order?
For example:
• What bothers you most right now?
• When and how did this begin?
• What other problems do you have?
• When were you last completely well?
——follow up with other searching questions?
For example, if a child has diarrhea:
• When did the problem begin?
• How many stools a day?
• What does the stool look like? (blood?
mucus? etc.)
• Has the child vomited? Urinated?
• Has the child been drinking liquids? What?
How much? How often?
• Does he eat? What? How often?
• Possible related illnesses? (earache, tonsils,
polio, malaria, etc.)
Did you find out about the following, if
necessary?
——Details of the problem—signs, dates, etc.?
——If others in the family or community suffer from
the same problem?
——The person’s living situation, if it might help
with diagnosis, treatment, or prevention?
——What medicines or treatments have already
been tried? And with what results?
PHYSICAL EXAMINATION Did you...
——conduct the physical exam in a sensible order?
——do what is least disturbing first?
For example, listening to a child’s lungs before
looking in his ears or throat.
——take precautions to make the exam as little
disturbing as possible?
For example:
• Explain tests and procedures ahead of time
(what you are going to do and why),
• Warm a cold stethoscope by rubbing the
bell before examining a child.
• Have the mother remove the child’s clothes
and hold him on her lap.
• Avoid unnecessary tests.
——make sure enough clothing was removed to
allow adequate examination?
——repeat doubtful or difficult examinations 2 or 3
times?
——do all necessary steps of the physical
examination, and leave out those not needed for
the particular problem?
DIAGNOSIS Did you . . .
——use a systematic approach to problem solving?
——consider different possible causes?
——ask questions or make tests to decide which
cause was most likely and which were not?
For example, the test for rebound pain when
appendicitis is suspected (WTND, p. 95).
——if you made a diagnosis, did you consider it
to be the probable cause of the problem? (Or
did you feel absolutely certain—a very risky
position to take?)
——make a sensible decision about what to do?
For example if you could not obtain enough
information to make a diagnosis, did you:
• Send the person for lab tests.
• Send him to a doctor you trust.
• If it could be done safely, treat the problem
according to the most likely diagnosis.
—— makegooduseofavailableresourcesforhelpingmake
the diagnosis? (books, instruments, people)
—— As nearly as can be told, did you make the right
diagnosis?