Playcaller, MD

What can NFL quarterbacks teach us about presenting patient cases effectively?

Matt Hasselbeck is best known for quarterbacking the Seattle Seahawks in the early 2000s, leading them to a handful of playoff appearances over his career. However, his career started with the Green Bay Packers, providing backup to one of the game’s greatest quarterbacks — Brett Favre.

In a recent podcast, Hasselbeck was asked about his time playing with Favre. One of his takeaways regarding Favre’s play-calling style was interesting to me. Before viewing the short clip, let me give some context.

In football, the quarterback is the field general, so-to-speak. Before a play is run, the quarterback gets the call from his coach and then relays that play to the offense. Sometimes he calls his own plays. All of this must take place quickly, as the play clock and/or game clock are always running. Everyone must know their roles, what play is being run, and the goal of the play. Effective communication, shared language, brevity, and clarity are necessary for everyone on the offense to execute the play successfully. The same can be said when presenting patients.

Below is the clip of interest…

Rookie vs Veteran

As Hasselbeck listened to Favre in the huddle, he noticed that it wasn’t the same as the “textbook.” For example, when Hasselbeck called plays, he would call them outright, giving equal attention to each portion of the play call. However, when Favre called that same play, he would give a “vibe” to it, imbuing vision when communicating to his team. As Hasselbeck himself put it, he would note there was a “deep post” on the play whereas Favre would emphasize “it’s not about the post — it’s a pop pass.” As if to say: sell the run, ball’s out quick, it’s going to the right, and we’ll score. I grew up watching Favre play… and I can tell you they scored a lot.

This was interesting to me as these same principles can be applied to the medical field, especially when it comes to communicating with the team as well as patients.

Again, some context — a primary part of a resident’s role is to elicit a history from the patient, perform a physical exam, appropriately assess them and create a plan of treatment. Part of this process includes presenting the patient’s “case” to the medical team. The medical team is comprised of other residents, many times a medical student or two, and an attending physician. The attending is the Favre to the resident’s Hasselbeck.

The format of the presentation can be understood via the acronym “SOAP,” which stands for Subjective, Objective, Assessment, and Plan. Each of these domains contains their own specific information. For example, under the “Subjective” domain a listener would expect to hear any findings from the patient interview, including but not limited to their past medical histories, current symptoms, medications, etc. In medical school, the acronym “OPQRSTAA” is commonly taught as part of the framework for this portion. (There are other frameworks to use, this is just the one I was taught). The “Objective” domain includes data like vital signs, physical exam findings, labs, etc. Assessment and Plan are exactly what you think they are.

The “OPQRSTAA” format. It’s an adequate format when discussing pain, however many of it’s items don’t apply when your patient’s main concern is anything other than pain.

The rookie’s goal is to collect information as the framework demands, ticking boxes as they go, and then present all of that information. However, a veteran understands the purpose of an effective presentation is to give the listener 2 and 2. By the time the veteran reaches their assessment of the situation — that assessment being the number “4” — their listener has already deduced the same... 4.

Instead of doing this, rookies give multiple numbers of varying relevance, which requires heavy lifting on the part of the listener. They must sift through the meaningless data and deduce the correct answer for their presenter. This wastes time and lacks clarity. Therefore, the rookie ought to develop veteran-level presentation skills as quickly as possible.

But how to transition from rookie to veteran? There are a couple of ways.

Start With The End in Mind

What problem are you trying to solve? For Favre, the problem was overcoming his opponent’s defense and scoring touchdowns. For the physician, it’s figuring out the correct diagnosis and implementing the proper treatment. This is how one should approach the patient interview and, later, the presentation. To do so, you must tailor your thinking around the patient’s chief concern.

For example, say a patient comes in with chest pain. When you hear “chest pain,” a list of possible etiologies should come into your mind. Your goal is twofold: to listen to your patient’s story and ask discerning questions to increase/decrease suspicion for specific diagnoses.

Despite that, the rookie enters the situation like an eager box-ticking machine, armed only with their acronyms. Instead of focusing on their patient’s concern, the rookie, without meaning to, focuses on their own concern of completing their questionnaire. The result is that both interview and exam meander aimlessly, which results in a meandering, ill-formed presentation.

On the other hand, the veteran enters the room with a strategy other than acronyms: their differential. They know the list of causes that can potentially cause chest pain. They know which questions to ask to narrow that list down. Therefore, the encounter is centered on figuring out their patient’s problem and not the rookie’s questionnaire. What results is a focused interview and exam. From this, what follows is a focused, logical, and clear presentation. You can’t chart a path if you don’t know where you’re going.

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Hypothesis-Driven, Not Data-Driven

Don’t get me wrong — data is of supreme importance. My point here is that not all data is of supreme importance.

Going back to our example: you started the encounter with a strategy, you’ve conducted your interview and exam with that strategy in mind, and now you should have a sense of what is going on with your patient. You present your case to the team and arrive at your assessment and plan. It is here, once again, where rookie and veteran differ.

The rookie’s presentation acts as a regurgitation of all previous findings. This is what I mean by data-driven: there is no synthesis of information, there is only information. Information without vision is meaningless and confusing.

In comparison, the veteran gives vision to the collected information through their hypothesis. They offer a realistic and effective plan in their presentation. This is what it means to be hypothesis-driven. Every piece of evidence, every beat in the story, is meant to support the diagnosis and its corresponding treatment.

Put differently, the rookie calls a pop pass but focuses on the deep post. The veteran calls a pop pass, emphasizes the pop pass, and scores. The doctor who thinks like the veteran will do the same: they’ll score.

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