H&P I: Click Here

H&P II: Click Here

1. What differences do you note between the two H&Ps?

My first HPI in Physical Diagnosis I H&P was very elaborate and not as succinct as my first HPI in PDII H&P, such that the complaints the patient presented seemed scattered throughout my HPI and the main reason the patient was in the ED was not concise. This reflects how I have learned to document the pertinent information in a more fluid manner. Additionally, my second H&P is not only more in depth in terms of a physical, but also has more history in it, which I attribute to becoming more comfortable with talking to patients.

2. In what ways has your history-taking improved?  Are you eliciting all the important information?

My history-taking has improved in my ability to ask patients uncomfortable questions and my attempts to describe what a particular symptom means. So far, I do believe I have been eliciting all the important information, however I do find it difficult to keep the patient engaged when doing a comprehensive history and physical as it can be extensive.

3. In what ways has writing an HPI improved? (hint: look at the rubric scores)

My HPI has improved in my ability to now include all components of OLD CARTS, whereas in my older HPI I only had 5-7 components. I have also improved in the flow of the “story” of my HPI and in my ability to write about how the patient got to where they are in present time.

4. What is your self-assessment of your current skill in performing a physical exam? Which areas do you feel strongest about/weakest about?

I do not feel as if I go into the physical exam very confidently and find myself getting caught up in thinking of the entire physical exam at once, especially when doing a comprehensive exam. Instead, I find it would be easier for myself if I just start head downwards and go through each in that manner. I feel strongest in the ENT areas and weakest in lungs and heart exam as well as neuro exam. Of note, I exclude fundoscopy from the ENT because I do not feel I have strong skills in that area of the exam.

5. 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? 

As I stated above, I will need to focus on heart and lungs in terms of being able to hear normal versus abnormal on a patient. Additionally, I will need to focus on the neuro exam, especially the tests used for potential stroke patients, in order to adequately assess the patient. I expect that once we revisit PD in the fall and as I continue onto clinical year and are doing multiple physicals a day, I will be able to gain more physical exam skills and feel more comfortable performing any exam.