- What differences do you note between the two H&Ps?
I missed some parts of family history in my H&P from the second semester whereas the family history I documented in my first H&P was extensive. The H&P from the second semester included more parts in the physical exam, an assessment and a plan. I think having to write an assessment and plan helped with taking a more thorough history in the second semester because I was narrowing down my differential diagnosis.
- In what ways has your history-taking improved? Are you eliciting all the important information?
My history taking has improved by asking the right questions for not only my patients’ chief complaint but also, I asked more questions based on what I was considering for my differential diagnosis. This urged me more all the important information. My history taking is more thorough in the second semester. Upon documenting screening tests, I started to write the results of the test which I didn’t do the first semester.
- In what ways has writing an HPI improved? (hint: look at the rubric scores)
The HPI from the second semester is more concise compared to the HPI from the first semester, while stilling including the pertinent information and elements of an HPI. The second-semester HPI presented the information in an orderly fashion. There were parts of the ROS that were missing but were pertinent for the HPI in the first semester.
- What is your self-assessment of your current skill in performing a physical exam? Which areas do you feel strongest about/weakest about?
In the beginning of the hospital visits, the first semester I would touch the patient lightly and gently, but I found that I was not doing the exam thoroughly since my palpation was not right. By the second semester, I was more comfortable with palpation. I feel strong in most of the physical exam. I think I do a good job of informing the patient of what I’m going to do and what I’m looking for. I feel weakest in listening for murmurs.
- 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?
For history taking, I will focus on getting more comfortable in asking sexual history. I would like to practice it during rotations and figure out what wording and flow is best for the patient. For the physical part, I would like to focus on knowing which parts of each physical exam I should do in a regular check-up, as well as for a patient with a complaint, since I won’t have the time to do every part of each system.
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