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

Several difference that can be noted upon inspection of both the first semester and second semester of Physical Diagnosis are the level of detail, complexity, and the confidence with which the H&Ps were written. Firstly, the level of detail was somewhat lacking especially in the HPI of the first H&P but can be seen to have increased in the latter H&P. There were also several things that the aspects such as the medications, family history, surgical history, and review of systems were not written confidently and seem to be missing some sort of information. While the latter H&P can be seen to have been written more confidently. Another difference that can be noted is that the initial H&P did not have proper usage of medical terminology which I believe to have improved in the latter H&P. Lastly, I believe that my skills at developing differential diagnoses have improved significantly since the beginning.

 

 

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

My history taking skills have improved mostly by knowing what the proper questions to ask to elicit more details from the patient about a certain symptom. I also believe that my history taking has improved by being able to incorporate some aspects of patient centered interviewing skills. One such aspect of patient centered interviewing skills includes the use of broad questions when initially approaching the patient in order to avoid leading the patient and eventually narrowing the questions. Another way that my history taking has improved is in the ease of asking and instinctively thinking of questions to help gain more information about a particular symptom such as OLD CARTS for a complaint of pain. Lastly, history taking has become an easier task due to the fact that the questions have become second nature.

 

 

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

One of the ways I believe that my skills at writing a HPI had improved that towards the latter H&P I was able to clearly visualize and construct a HPI before writing it down. Secondly, I believe that initially my skills at organizing the HPI were lacking but have since improved.  I was also able to properly filter out and include only the relevant material in a HPI which I believe was one of my weaknesses initially. Looking back at the second semester H&P, I came to realize that I was able to properly write and organize an HPI even in some of the most complex cases that I had encountered. 

 

 

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

In a self-assessment of my current skills in performing a physical exam I believe I am more confident when it comes to interacting and touching the patient. Additionally, constantly repeating the physical exam on several patients throughout the semester in different settings of the hospital has helped to reinforce some of the weaker skills such as general survey, vital signs, and eye exam. I believe that even at this point my skills at performing a thorough physical exam would not be enough to complete it in a time frame of less than 20 minutes.

 

 

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 believe that I would need to improve my physical exam skills and try to become more proficient and confident in them. One of the main aspects of the physical exam skills I would like to improve on would be able to perform a head to toe full physical exam without having to consciously think about the next step of the exam. I also believe that another aspect of the physical exam that I would need to improve would be to be able to do it in quicker and more efficiently. Lastly, being able to build rapport with the patient as I am conducting a history and physical is another aspect that I would like to improve on.