1. What differences do you note between the two H&Ps?
The main difference I see between my H&Ps is my quality of my HPI and the use of pertinent positives. Just because one of HPIs is lengthy doesn’t necessarily mean its better, I think my latest H&P is more direct but it is as detailed as it needs to be. Another difference I note is just in the manner I present some of my findings, in my second H&P, I am better able to describe my exam results thus formulating a clearer note. However, my assessment and plan for both seem to be lacking.
2. In what ways has your history-taking improved? Are you eliciting all the important information?
I think my history taking has improved. I have become more comfortable especially in asking personal questions. I think that was a struggle for me. I also try to focus my questioning in an orderly fashion therefore I am assessing the patient while they are depicting their symptoms to me. But depends on the time constraints and surroundings I have always tried to come back if a question was adequately answered however surgical history I have noticed and sexual history have sometimes been overlooked.
3. In what ways has writing an HPI improved?
I think I have improved in my story telling during the HPI, I am focused on the patients chief complaint. With this is mind I use OLD CARTS mnemonic to help guide my synopsis of the patients case. I may have forgotten some elements which I need to practice more about remembering to ask in each patient interaction. I incorporated elements that show my style. I did well on using a variety of language and being concise during the review of systems, and physical when the patient was normal.
4. What is your self-assessment of your current skill in performing a physical exam? Which areas do you feel strongest about/weakest about?
My self assessment of my current skills in performing a physical exam would be a 6/10. I am not near perfect yet. I can perform a physical exam on a normal, no complaint patient, and state what I am looking for and maybe even normal findings to say the least. However, I think the challenging aspect for me is having a patient who you’re completely unknown to their symptoms and kind of guiding the physical exam towards their described symptoms is a bit harder. Because the abnormalities and findings aren’t so black and white, and I haven’t been able to piece everything together.
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?
One specific area that I will target as needing my particular focus in future patients vistis when I start clinical year is from the start once the patient describes their symptoms, I start formulating differentials. I think this is the most hardest for me, because its not just about thinking about what the patient may have but remember the proper workup for it and then tailoring it to this specific patients case, since it may need to be altered. This is determined while I am obtaining their information through the history. The early thought process will help to guide me in a better direction in terms of asking better directed questions and asking questions that reveal more about the patients diagnosis. And long term this I think will help me better my assessment and plan which I have had difficulties with as well, not knowing what to prescribe or how to treat in what circumstances and in what conditions.