What differences do you note between the two H&Ps?
In the 1st H&P, I noticed I omitted important detail such as length of ongoing medical conditions and noting limited information about the patient’s general appearance. I made sure not to forget these details during my next patient encounters by writing a note in my hospital notebook. During my last hospital visit I did have less time to perform the history and physical but I noticed I was relying less on my notes during my questioning and performed the interview portion faster. I had to omit some portions of the physical exam like visual acuity and fundoscopy and performed a more focus physical exam in order to do some portions of the Heart and Lung exam we recently learned in lab.
In what ways has your history-taking improved? Are you eliciting all the important information?
My history taking has improved with taking the HPI and eliciting the details of the chief complaint using OLD CARTS. I still need to work on eliciting the most important information by developing a broader differential diagnosis on the spot during my patient encounter. I have gotten better at the ROS questions but there are still certain things I would forget to ask if I didn’t have my notes during the interview.
In what ways has writing an HPI improved?
Compared to my 1st H&P, in my 3rd H&P I am providing more information about the patient’s general appearance, past medical history and family history. In addition, I do think my 3rd HPI provides a more detailed picture of the patient’s condition.
What is your self-assessment of your current skill in performing a physical exam? Which areas do you feel strongest about/weakest about?
In terms of physical exam, I find that my strengths are skin, ears and neck. I don’t feel 100% in these areas but I do feel more comfortable in identifying what is normal versus worrisome. I feel least confident with my Lung and Heart exam, only because I feel I haven’t heard enough heart or lung sounds on various patients to differentiate between normal and abnormal.
Of course we expect you to get stronger in all areas, but which of the specific areas will you target as needing particular focus in future patient visits when you start the clinical year?
I will continue to work on my H&P by working on my differential diagnosis and actively thinking of questions I can ask while I am interviewing the patient to elicit as much information possible in order to determine what diagnosis is more/less likely. I aim to strengthen all aspects of my physical exam but will certainly focus on becoming more confident with the lung, heart and abdominal exam. During clinical rotations, I will have the opportunity to perform these exams on a variety of patients and will focus on getting better at identifying what is considered normal and abnormal.
