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How to present in family medicine clinic

Family medicine presentations happen between visits, to a preceptor with a full schedule of their own. You get two to three minutes while the patient waits in the room. A good clinic presentation is organized by the problems the patient came in with, says what the patient wants, and ends with a plan you are ready to defend.

Target
2 to 3 minutes to your preceptor, between visits
Lead with
Today's agenda, then a plan the patient agrees to

Here is the outpatient SOAP format, a word-for-word example from a fictional diabetes follow-up, and the screening and chronic care questions that come up in clinic.

What your attending listens for

Family medicine preceptors are seeing their own patients while they listen to you. They want why the patient came in today, the few findings that matter for each problem, and a plan you commit to, including what the patient wants when there is a real choice. Then the preventive care that is due, and the follow-up.

The structure

  1. Step 1: One-liner and agenda

    Age, sex, relevant chronic conditions, and why the patient came in. If they brought several concerns, say which you agreed to address today.

  2. Step 2: Subjective, by problem

    For each problem: symptoms, home readings, adherence and side effects, and pertinent positives and negatives. Only the history that bears on today.

  3. Step 3: Objective

    Vitals with BMI (repeat a high blood pressure), a focused exam, and results since the last visit, such as a point-of-care A1c, a BMP or the urine albumin-to-creatinine ratio.

  4. Step 4: Assessment and plan, with shared decisions

    For each problem: at goal or not, why, and the change you would make. When there is a real choice, name the options you discussed and what the patient prefers.

  5. Step 5: Preventive care due

    The screenings and vaccines due for age and risk, and what the patient accepted or declined. Keep it to a line at a visit for an acute problem.

  6. Step 6: Follow-up and return precautions

    When to come back and what to check before then, and the symptoms that should bring the patient in sooner.

A word-for-word example

Clinic, presenting to the preceptor between visits. A fictional patient.

  1. Step 1: One-liner and agenda

    Mr. Brooks is a 56-year-old man with type 2 diabetes and hypertension, here for a 3-month diabetes follow-up. He also raised knee pain; we agreed to book a separate visit for it.

  2. Step 2: Subjective, by problem

    Home fasting sugars run 150 to 180, with no lows. He takes metformin 1,000 milligrams twice daily, missing about one dose a week, plus lisinopril and atorvastatin. No polyuria, foot numbness or vision changes. Home blood pressures average 124/78. He has gained 6 pounds and wants help losing weight.

  3. Step 3: Objective

    Blood pressure 128/78, BMI 33. Normal monofilament exam, 2+ pedal pulses, no foot ulcers. A1c today is 8.4%, up from 7.6% in July, when his eGFR was 88 and urine albumin-to-creatinine ratio 12.

  4. Step 4: Assessment and plan, with shared decisions

    #1, type 2 diabetes, above his goal of under 7% on metformin. We discussed a weekly GLP-1 receptor agonist injection, which also helps with weight, or a daily SGLT2 inhibitor pill; he prefers the injection. With no personal or family history of medullary thyroid cancer or MEN2, I would start semaglutide 0.25 milligrams weekly, increasing every 4 weeks as tolerated. #2, hypertension, at goal.

  5. Step 5: Preventive care due

    He has never had colon cancer screening and chose a FIT kit over colonoscopy. He wants his flu shot and first shingles vaccine dose today, and needs a diabetic eye exam.

  6. Step 6: Follow-up and return precautions

    Follow-up in 3 months with an A1c, sooner for severe abdominal pain or vomiting that keeps him from drinking.

Ward pearls

  • Commit to an assessment and a plan before you are asked. Many preceptors teach with the one-minute preceptor model, which starts there.
  • Say what the patient wants: "he prefers a pill" or "she wants 3 months of diet and exercise first" is part of the plan.
  • Ask about adherence and cost before adding a drug. Missed doses and unaffordable refills explain many numbers above goal.
  • Check what preventive care is due before you walk in, so you can offer it in the room.

Classic pimp questions

  • Colorectal cancer screening from age 45: colonoscopy every 10 years, FIT every year, or stool DNA-FIT every 1 to 3 years
  • The USPSTF lung cancer screening criteria: age 50 to 80, 20 pack-years, and smoking now or quit within the past 15 years
  • Type 2 diabetes: who needs a GLP-1 receptor agonist or SGLT2 inhibitor whatever the A1c (ASCVD, heart failure, CKD)
  • Hypertension: confirming it outside the office, the goal of under 130/80, and the first-line drug classes

Not sure how to field them? How to take the questions

Practice it out loud

A script you have read is not one you can say. Present a fictional patient to an AI attending who cuts in, asks why, and grades you on a rubric, then drills whatever you missed.

Try a free case

One case, free. No signup, no card.

Other rotations

Educational content with fictional patients, not medical advice. Teams and institutions differ: follow your attending, your institution's protocols and current guidelines.

Family medicine oral presentation: the outpatient SOAP format | Rounds