Practice Perfect 849
Staying Informed Using the One-Pager Method
Staying Informed Using the One-Pager Method
I saw an interesting patient recently. We all know what an “interesting” patient is: one which has an uncommon or hard-to-make diagnosis, something we don’t see every day. I had one of those patients the other day. This interesting case is also a great opportunity to discuss the “one-pager” method that I recommend for all trainees, and, in fact, all of us when approaching a learning topic. Let’s have a little fun figuring out the diagnosis with a case presentation and then discuss the one-pager.
Case – Bumpy Red Legs
This is the case of a 56-year-old male (details changed to maintain privacy) complaining of bilateral leg bumps and left heel pain for the past 10 days. He relates pain to these areas that is a 7-8/10 pain that is sharp and reverberating in quality. He denies new medications, travel, or activity changes. His medical history is significant for spinal arthritis and multilevel fusion but is otherwise negative. He denies smoking and drinking and works as a computer programmer. He takes no medications.
On physical examination there are bilaterally symmetrical tender erythematous nodules on the pretibial areas measuring approximately 2-3 cm. The left medial heel also has an erythematous nodule that is painful to palpation. The rest of the examination is negative. I initiated treatment with a short term oral methylprednisolone, which improved the symptoms and resolved the nodules 2 weeks later at our first follow up appointment.
What’s your diagnosis? Not to burst your enthusiasm, but I don’t have a certain diagnosis. However, this clinical appearance and the response to oral corticosteroids seems most consistent with erythema nodosum.
As this is not a terribly common condition for me (in fact it’s been a number of years since I’ve seen a patient with this – or at least recognized it), I thought it was time to brush up and review, and also to use that information to further my patient’s work-up.
There are a couple of problems with being an active provider in practice, the most significant one being a lack of time. As such, it’s imperative to have a high-yield, efficient method to gather and retain information. I never thought the day would come that I’d recommend YouTube, but I have to say there are some very good videos about almost any topic coming from quality medical educators. Be careful not to fall down the rabbit hole and follow interesting video links to oblivion! For this topic, because it’s a more medically related one, I used UpToDate and found a reasonably concise discussion1. Using this source, I took 20 minutes and created a single page document we call a One-Pager.
UpToDate Article on Erythema Nodosum
My 1 Pager Summary on Erythema Nodosum
I’ll mention a couple of points about this One-Pager. I use an iPAD and an application called Notability to organize PDFs and take notes. I’m still a lover of the printed page, so this app allows me to write my notes with an Apple Pencil and stay organized. As a result, you’ll note this document is hand-written and kind of messy. I covered the main points and used a bulleted format. Writing out the notes rather than simply reading and memorizing the UpToDate article is a more active method of learning that yields deeper and longer retention while also giving me a short document to refer back to later when I invariably forget some of this.
I will also comment that this method subscribes closely to adult learning theories that state adults learn best when we decide what to learn about, using our experience to guide research, is problem-oriented, and has immediate relevance.
The bottom line is I created a fast, high-yield reference in an active manner that is case-based, keeping me informed. Give the One-Pager a try the next time you have a clinical question. On to the next patient!
Best wishes.
Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]
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Kroshinsky D. Erythema Nodosum. UpToDate. Last updated 1/24/2020. Last accessed 2/10/2023.
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