Links to History and Physicals:

This is one of the first history and physicals I had written: hp_sept2017

This is a more recent history and physical: hp_may2018

The following is a reflection regarding the differences between my history and physical written in September 2017 verses the one written in May 2018:

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

Along with the decreased amount of red ink from the first to second H&P, there are several other differences worth noting. My H&Ps have gotten more concise; I am able to better distinguish what information belongs in the HPI and what information does not. Similarly, I have improved my ability to prioritize and rank information presented within the HPI as to give the a more efficient clinical snapshot for its next reader. Aside from the HPI, I am more thorough in my recording of medications and review of systems. I still need to work on my recording of abnormal findings and ability to go sequentially through my physical exam in the quickest but most effective way possible

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

When approaching patients, I am less nervous and therefore forget fewer questions. During my first hospital visit, I was very nervous and forgot to ask about the route by which they took their medications, reactions to specific allergies, their last dental and eye exam. By my last hospital visit, these questions felt more like second nature and didn’t require a prompt or a cheat sheet for me to remember to ask.
My ability to ask more well-rounded questions has also greatly improved. During my first hospital visit, I was simply methodically asking questions to make sure I filled out the H&P outline I had brought for myself. By my final visit, I was less focused about filling out every detail but asking specific questions geared toward their symptoms so I could gain a better clinical picture of their situation and therefore better assess and treat them.

In what ways has writing an HPI improved?

As mentioned previously, they have become more efficient. I can more easily identify extraneous details that do not add significant information to the clinical picture and insert them into the ROS rather than the HPI. Likewise, I better understand the “language” used in an HPI. I had been referring to the patient by her name during my first HPI but now simply refer to patients as “the patient.” Likewise, HPIs are meant to give quick, effective snapshots. I am better at stitching together information to create a clearer clinical picture.

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

I have the tools and knowledge I need to perform a complete physical exam.  For example, I feel confident in my ability to do EOMs or ask the pertinent questions of a neurological exam. However, I need to continuously practice and repeat them on different people and in different stressful situations. I often will practice with a family member or a classmate, but now because I know their expected physical findings, I quickly go through the exam. I need to palpate an enlarged liver or spleen or see pale conjunctiva or see a bulging tympanic membrane with an obscured cone of light to truly feel confident that I will be able to identify these abnormalities when I come across them. Likewise, I need to be able to do these exams when I only have 10 minutes to examine a patient.

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?

Before starting my clinical year, I hope to extensively review heart and lung sounds. I would largely benefit from going through the SimMan heart and lung sounds again. Similarly, I will extensively review differential diagnoses for specific general symptoms like productive and nonproductive cough, chest pain, abdominal pain, etc. Special examinations for the upper extremity will likely require a review as well.