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How to present a patient on rounds

Every rotation asks you to do the same hard thing: stand in front of your team, tell a patient's story out loud in a few minutes, then take questions. That is the oral case presentation, and it is one of the main ways attendings judge how well you know your patients and how you think.

The details change from service to service. The skeleton does not. Learn it once, then adjust the length and the emphasis for each rotation.

The structure that works everywhere

  1. Step 1: One-liner

    Who the patient is and why they are here, in one sentence: age, sex, the few conditions that matter, and the presenting problem.

  2. Step 2: Subjective

    For a new patient, the history of present illness. For a follow-up, what happened overnight and how the patient feels today.

  3. Step 3: Objective

    Vitals, a focused exam, then labs and imaging. Give the numbers that matter and which way they are moving.

  4. Step 4: Assessment

    A summary statement: what you think is going on, and why.

  5. Step 5: Plan

    Problem by problem, most serious first, with what you want to do today.

A new admission adds the full history between the subjective and the objective: past medical and surgical history, medications and allergies, family and social history, and the review of systems. A follow-up on rounds leaves it out.

How long it should take

Length is set by the service. Surgery and labor and delivery want a minute or so, medicine wants the whole picture, and the ED wants to know in one sentence whether to walk into the room. Each guide below has the format for its rotation, a word-for-word example and the questions that come up.

What attendings notice

  • Reading the chart in order. A presentation is an argument for your assessment, not a transcript of the chart. Say what supports your thinking and leave out the rest.
  • Numbers without meaning. "Creatinine 1.8" is data. "Creatinine 1.8, up from a baseline of 1.0" is a finding.
  • No commitment. Name your leading diagnosis and defend it. "I think this is X because of Y, and I am less worried about Z because..." is the sentence attendings are waiting for.
  • "Labs within normal limits." Give the values that matter. The attending will ask for them anyway.
  • A plan that is only a list of tests. Say what you would do with each result.
  • Dropping the ending. Code status, prophylaxis, lines, and what stands between the patient and discharge belong in every inpatient plan.

How to take the questions

Most attendings ask questions to find the edge of what you know, not to embarrass you. Answer the question that was asked, and commit when you have an answer. When you do not know, say so and say how you would find out: "I'm not sure. I'd check the guideline, and I can have an answer by this afternoon." Then follow up.

Thinking out loud is fine, and often better than silence. Reason from what you do know, and say when you are guessing.

How to prepare the night before

  1. Preround. See the patient, then check overnight events, vitals, ins and outs, new labs and imaging, and the medication list.

  2. Write a short script. The one-liner, your assessment and the plan by problem. Do not read it word for word on rounds.

  3. Say it out loud, and time it. A presentation that sounds tight in your head usually runs long out loud.

  4. Know the one-liner and the plan cold. They are the parts the team remembers.

Want every rotation on paper? See the cheat sheet pack, or download it now (PDF, 8 pages, 362 KB).

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.

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

How to present a patient on rounds: the oral case presentation | Rounds