E5.8

The Case Presentation

A 3-5 minute structured presentation that conveys the patient and the clinical reasoning to colleagues, consultants, or supervisors.

Encounter card

Setting

Consultations, rounds, supervision, peer review, sign-out.

Opening move

Structure: identifying data → chief complaint → HPI → past psychiatric/medical → social → MSE → formulation → plan/question. Use the listener's time efficiently. End with what you're asking for.

Sample language

"Mr. Hayes is a 38-year-old married software engineer presenting with new-onset depression. Chief complaint: "I can't function." HPI: 6 weeks of low mood, anhedonia, insomnia, anorexia with 15-lb weight loss, recurrent passive SI, no plan. Onset coincided with job loss. Past psychiatric: one prior depressive episode age 25, treated with sertraline with full response. Family history: paternal MDD. Social: married, supportive spouse, financial pressure now. MSE: dysthymic affect, congruent mood, no psychosis, intact cognition, fair insight. Formulation: recurrent MDD precipitated by job loss with biological loading. Plan: restart sertraline, weekly follow-up, return precautions reviewed. Question: would you support outpatient management given passive SI without plan?"

Listen for

(this is what you produce, not what you listen for)

Common pitfalls

Drowning in detail without organization. Skipping the question you're actually asking. Burying the diagnosis. Starting with chart numbers instead of patient.

Red flags / escalate: Listener cannot recap who the patient is or what the clinical question is — restructure.

Documentation

The case presentation is verbal; the written counterpart is the formal note.

Real-world reality: Case presentations in real clinical settings (rounds, sign-out, consultation) are often 30-90 seconds, not 5 minutes. The compressed version requires more discipline than the full version.

A good case presentation respects the listener's time and ends with a specific question. It is a clinical skill, not a recitation.

Warm grey-tinted clinical notebook page, deep ochre accent. The case presentation structure — ID → CC → HPI → past → social → MSE → formulation → plan/question. Margin clusters on each.

The case presentation is a structured communication that conveys a patient to colleagues, consultants, or supervisors in 3-5 minutes. Done well, the listener understands the patient and the clinical question quickly. Done poorly, the listener loses the thread in irrelevant detail or misses the question entirely.

Standard structure in order: identifying data (age, sex, relevant demographic context); chief complaint (the patient's words); HPI (the brief narrative of the current episode); past psychiatric history (relevant prior episodes and treatments); medical history and current medications; social history (relevant elements); MSE (key findings); formulation (the integrative one-paragraph synthesis); assessment and plan; specific question or ask.

End with the specific question. "I'm asking for your input on..." or "I'm wondering whether to..." or "Would you support outpatient management given..." The listener uses the question to organize their thinking. Vague endings ("any thoughts?") waste the listener's time and yours.

Edit for time. The 3-minute presentation focuses on what changes management. The 8-minute presentation can include more detail. For most settings — quick consultation in a hallway, presentation in a busy team meeting, sign-out — 3-5 minutes is the target. Cut detail that doesn't change the clinical thinking.

Sample structure: "Mr. K is a 45-year-old married accountant presenting with first episode of severe depression. Chief complaint: 'I can't do this anymore.' HPI: 8 weeks of severe depression with passive suicidal ideation, no plan, anhedonia, weight loss, insomnia, work performance has declined to the point his job is at risk. No prior psychiatric history. No medical issues; on no medications. Family history of bipolar in mother. Social: marriage stressed by his withdrawal; financially stable. MSE: dysphoric affect, congruent mood, no psychosis, intact cognition, fair insight. Formulation: first episode severe MDD with notable family history of bipolar — bipolar II remains on differential. Plan: start sertraline 50 mg, weekly follow-up, safety plan reviewed, return precautions. Question: given the family history, should I start a mood stabilizer alongside, or is SSRI alone appropriate first-pass?"

That presentation, with practice, takes about 3 minutes. The listener can engage with the specific question quickly. The patient is presented as a person, not just a case.

Ending with the specific question — what you're asking the listener for. Sample examples. Margin notes on why this matters.

The anchor

A case presentation is a structured 3-5 minute communication that conveys the patient and the clinical question. Edit for time, end with the question.

Editing for time — what to include and what to leave out when presenting in 3 minutes vs 8 minutes. Margin clusters on prioritization.

Prove it

You're presenting a new admission to the attending in 2 minutes. The patient is complex — chronic schizophrenia, multiple psychosocial issues, recent suicide attempt. How do you compress?

This connects to

E5.1

Biopsychosocial Formulation

What the presentation summarizes.

E12.2

Sign-out & Handoff

A specific case-presentation format.

Locked concepts unlock as you reach them on the path.