What the doctor–doctor conversation is about
The case presentation is the handover that takes place several times a day in every German hospital: on the ward round, on the phone, in the morning meeting. The senior physician has little time and wants to know three things: Who is the patient, what do they have, what do we do now. Everything else is reasoning.
What is graded is whether you command the professional register confidently (now „Nausea und Emesis“, not „Übelkeit und Erbrechen“), whether the presentation is structured and spoken freely, and whether you answer follow-up questions with confidence – including those designed to throw you off. A typical mistake: reading out the report you have just written. The examiners spot that immediately, because written language sounds different from a spoken handover.
The structure step by step
Case presentation step by step
The presentation to the senior physician always follows the same order. Click through — for each step you see a model phrase and an example from a real case.
Opening
One sentence. Then straight to the patient – no preamble about the circumstances.
Guten Tag, Herr Oberarzt.
Good afternoon, doctor.
Ich habe heute einen neuen Patienten aufgenommen und würde gerne mit Ihnen seinen Fall besprechen.
I've admitted a new patient today and would like to discuss the case with you.
Guten Tag, Herr Oberarzt, ich habe heute einen neuen Patienten gesehen und würde Ihnen seinen Fall gerne vorstellen.
Two registers, one case
The same patient described twice: on the left the way you said it to the patient – on the right the way you say it to the senior physician. If you have both columns in your head, you switch automatically in the exam.
| To the patient (part 1) | To the senior physician (part 3) |
|---|---|
| Sie haben seit gestern Bauchschmerzen, die erst um den Nabel waren und jetzt rechts unten sind. | Seit 24 Stunden bestehende, von periumbilikal in den rechten Unterbauch wandernde Abdominalschmerzen. |
| Ihnen ist übel, Sie haben einmal erbrochen und hatten 38,4 Fieber. | Begleitend Nausea, einmalige Emesis, Fieber bis 38,4 °C. |
| Beim Husten tut es mehr weh. | Schmerzverstärkung bei Husten und Erschütterung. |
| Es könnte eine Entzündung des Blinddarms sein. | Dringender Verdacht auf akute Appendizitis. |
| Wir machen einen Ultraschall vom Bauch und nehmen Blut ab. | Sonografie des Abdomens, Labor mit Blutbild und CRP. |
The senior physician’s follow-up questions
After the presentation the real conversation begins. The questions are remarkably consistent across exam reports:
- „Warum gehen Sie von einer Appendizitis aus und nicht von einer Gastroenteritis?“ (Why appendicitis and not gastroenteritis?) – reasoning via leading symptom and course.
- „Welche Untersuchung machen Sie zuerst und warum?“ (Which examination first, and why?) – order with reasoning: clinical first, then labs and ultrasound.
- „Was bedeutet Loslassschmerz? Erklären Sie das dem Patienten.“ (What does rebound tenderness mean? Explain it to the patient.) – switching register on command, the classic.
- „Welche Komplikation fürchten Sie?“ (Which complication do you fear?) – perforation, peritonitis; brief, no lecture.
- „Der Patient will nach Hause. Was sagen Sie ihm?“ (The patient wants to go home. What do you tell him?) – back to plain language, pick up the worry, explain the risk.
The right attitude: answer briefly, give reasons, be honest when unsure („Das würde ich mit dem Chirurgen besprechen“ – I would discuss that with the surgeon). The examiners are not looking for medical mistakes; they want to hear whether you can hold your own in a professional conversation.
Vorstellung: Verdachtsdiagnose
- Advanced
Auf Grundlage der Anamnese gehe ich am ehesten von einer akuten Cholezystitis aus.
Based on the history, I most likely suspect acute cholecystitis.
- Advanced
Die anamnestischen Angaben sprechen am ehesten für eine Gallenkolik.
The history most likely points to a biliary colic.
Vorstellung: Weiteres Vorgehen
- Advanced
Als erste Maßnahme erfolgt die körperliche Untersuchung.
As a first step, a physical examination is performed.
- Advanced
Zur weiteren Abklärung und Sicherung der Verdachtsdiagnose empfehle ich eine Sonografie und Laboruntersuchungen.
For further clarification and to confirm the suspected diagnosis, I recommend an ultrasound and lab tests.
- Advanced
Bei Bestätigung des Verdachts erfolgt eine Therapie mit Analgetika und Spasmolytika.
If the suspicion is confirmed, treatment with analgesics and antispasmodics is administered.
Frequently asked questions about the case presentation
How long should the presentation be?
Two to four minutes spoken freely. Then the senior physician asks questions. Anyone talking for more than five minutes is usually interrupted – a sign that the key message is missing.
May I use my notes?
Yes, as a memory aid. You should not read aloud – the examiners grade free speech. Glancing at your keywords between two sections is completely normal.
What if I do not know the suspected diagnosis?
Then you present the leading symptom with the most likely causes and say which examination will decide. That is medically correct and linguistically complete – expressing uncertainty with confidence is part of the skill.
How do I practise the presentation without a senior physician?
Out loud, with a stopwatch, following the fixed structure – on a case whose history you took yourself. In FSPkurs an AI senior physician asks the follow-up questions and grades structure, register and reasoning.