How to present a case to a consultant without losing the room

A good presentation is ninety seconds long and answers the question the consultant is already asking. A structure you can use from your first round.

A case presentation is not a recitation of everything you know about a patient. It is an argument, delivered under time pressure, to someone who has to make a decision. Once you see it that way the structure becomes obvious and the nerves get smaller.

Ninety seconds is the target

On a busy round you have somewhere between sixty and ninety seconds before attention moves on. That is enough for roughly a hundred and fifty words, which is far less than most learners plan for. The discipline of the time limit is what forces you to decide what actually matters.

The structure

• One opening line: age, relevant background, and the problem that brought them in.
• The history that bears on the decision, and nothing that does not.
• Positive findings, then the negatives that genuinely narrow the differential.
• Results you have, and results you are waiting for.
• Your working diagnosis, stated as a commitment rather than a list.
• What you have done and what you propose to do next.

The opening line does most of the work

"Fifty-eight year old man, diabetic for twelve years, admitted overnight with three days of breathlessness and a productive cough." That sentence has already told the listener which mental pathway to open. Compare it with "This is a patient who came to casualty last night," which has told them nothing and spent five of your ninety seconds doing it.

Negatives are not filler

New presenters either omit negatives entirely or read out every system. Neither is right. Include a negative when its absence changes the differential: no chest pain, no calf swelling, no fever. Those three shape the picture. Whether the patient has ever had a headache does not.

Commit to a diagnosis

The hardest habit to build is ending with a position rather than a list. "My working diagnosis is community-acquired pneumonia, with decompensated heart failure as the main alternative" invites a useful correction. "It could be pneumonia or heart failure or a COPD exacerbation or possibly a PE" invites nothing, because you have handed the thinking back.

Being corrected is not the failure mode here. Being uncorrectable is, because a listener cannot argue with a position you never took.

Practise on your own patients

Before the round, present the case to yourself in the corridor, out loud, timed. You will discover which parts you do not actually understand, because those are the parts you cannot say in a short sentence. Fix them before the round rather than during it.