Your first ten patients: a practical protocol for new graduates

The problem with the first month

You know more Materia Medica than you will need for a routine case. What you do not yet have is a process — and without one every consultation becomes an improvisation, which is exhausting and produces inconsistent records.

Borrow a structure until you have built your own.

Before the patient arrives

Decide two things in advance, in writing:

1. How long a first consultation takes. Forty-five minutes to an hour for a chronic case. Booking chronic cases into fifteen-minute slots is the fastest way to produce bad case records.
2. What you will record every time. A fixed template beats a blank page — you will not remember to ask about thermals at 6 p.m. on a Friday.

During: three phases, kept separate

Phase 1 — let them talk. Do not interrupt for the first several minutes. What patients volunteer first, and the words they choose, is information you cannot recover later by questioning. Write their phrasing verbatim, not your paraphrase.

Phase 2 — complete the picture. Now fill gaps systematically: generals, thermals, sleep, appetite, desires and aversions, menses where relevant, history, family history, the exciting cause.

Phase 3 — observe. Manner, posture, how they respond when asked about difficult material, whether they contradict themselves. This is data, and it is the part that never appears on a form.

After: analyse away from the patient

Early on, avoid prescribing in the room. Tell the patient you will review the case and come back to them. This is normal, defensible, and prevents the commonest beginner error — reaching for the remedy that came to mind in minute three and then unconsciously collecting evidence for it.

Record what you predicted

Before the follow-up, write down what you expect to change and by when. This single habit will teach you more in ten cases than fifty cases of unstructured follow-up, because it forces your reasoning to be falsifiable.

Know your referral threshold in advance

Decide now — not mid-consultation — what makes you refer or investigate rather than prescribe. Red-flag symptoms, deterioration, anything outside your scope. Having the line drawn before you meet the patient is what makes it possible to hold when you are inexperienced and want to help.

Practise the process, not just the knowledge

Case-taking is a motor skill; it improves by repetition with feedback. Working simulated cases lets you rehearse the sequence — talk, complete, observe, analyse — without a real patient absorbing your learning curve. That is the whole reason the case simulator exists.

Your judgement will arrive. The structure is what carries you until it does.