As a medical student, treating a patient with a pan-positive review of systems (ROS) or multiple concerns can be overwhelming. It’s easy to feel like you’re drowning in a sea of symptoms and requests, but fortunately, there are approaches you can take to tackle these challenges and provide the best care for your patients. In this episode, Andy and John are joined by one of our blog writers, Shannon Caliri, DO, and guest Meenal Sharkey, MD to discuss tips for navigating the pan-positive patient.

When a patient presents with multiple complaints or a pan-positive ROS, it’s important to remember that this can be a lengthy and complex list. But don’t panic! Take a breath and understand that there may be connections worth considering between these symptoms. Do your best to pull the symptoms together into a cohesive story or at least choose what you think the most important or concerning part of their story is. Try your best not to “move the disaster” by regurgitating what you heard from the patient straight back to your resident or attending.

Try to tease out the chronicity of their multiple complaints. It can also be helpful to ask the patient what they are most concerned about today. This may help you prioritize which complaints should be addressed first and can also help you understand the patient’s expectations.

Throughout the patient’s visit, it’s essential to circle back and update them on what you’ve discovered and what complaints you’ll be addressing. Taking this step will not only help the patient understand that they are being heard, but it will also show that you are taking ownership of the patient.

Finally, be sure to always consider deeper social issues when someone presents as pan-positive. Be sure to keep an open mind about these patients and inquire with your resident or attending what resources are available at the hospital you are at for patients who may need assistance with housing, food, etc.

Navigating the pan-positive patient can seem like a daunting task, but with these approaches, you can tackle those challenges head-on. Always make sure to communicate with your resident or attending. It’s crucial to tease out the chronicity of their symptoms, circle back during their visit, consider social issues, set appropriate boundaries, and make the patient a part of their care. With these skills, you’ll be able to provide the best care for your patients and help prioritize their medical needs.

Take Homes:
  • Try to pull together a cohesive story from the many concerns
  • Try not to “move the disaster”
  • “What most concerns you today? What prompted you to call the ambulance today?”
  • Set appropriate boundaries
  • Consider alternative social issues
  • Make the patient a part of their care

Post by Patricia Capone, DO PGY-2


About Our Guest:

Shannon Caliri, DO PGY-3
Chief Resident, AdventHealth East Orlando Emergency Medicine Residency Program

Meenal Sharkey, MD
Clerkship Director, OhioHealth Doctors Hospital Emergency Medicine Residency Program

  3. Bayer S, Kuzmickas P, Boissy A, Rose SL, Mercer MB. Categorizing and Rating Patient Complaints: An Innovative Approach to Improve Patient Experience. Journal of Patient Experience. January 2021. doi:10.1177/2374373521998624
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The Pan Positive Patient – Med Student Over Easy

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