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

I decided to compare my very first H&P with a more recent one, and the difference in information gathering, medical knowledge, and organization is simply incredible. To be somewhat fair to myself, I was using a translation service and was very nervous interacting with a patient in a clinical setting for the first time, so I made some mistakes. For example, I recorded that the patient was getting a pre-cancerous fibroid removed, and I now know that fibroids are benign growths, so this was an error on my part in being able to elicit the correct information. I also failed to put relevant findings from the review of systems into the HPI to make things flow more logically and help identify pertinent positives and negatives, which is something I corrected for in my other H&P.

 

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

I believe my history taking has improved, and I think that this is related to becoming more familiar with the clinical setting and being able to recall the correct questions that I needed to ask the patient. My second H&P had much more information, though this might also might be due in part to the first H&P being in Pre-Admission Testing. I was able to create a better timeline of events for organizational purposes which will also aid in figuring out differential diagnoses.

 

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

As previously mentioned, I think the logic and flow of my HPI has improved dramatically and the content and focus are much better. I think my ability to analyze the clinical situation is not developed as strongly yet, as I feel I need more experience to be able to make connections and form better ideas to arrive at the correct diagnosis.

 

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 believe that I’m able to perform most of the physical exams we’ve been taught well, but interpreting any abnormal results is something that I need to work on. For example, one patient I was assigned to was suspected of having tuberculosis or a severe pneumonia, and the attending physician I presented to told me she heard some adventitious sounds in the patient’s lungs. I wasn’t able to hear these sounds for myself, either because I haven’t trained my ear to be able to distinguish between “normal” and “abnormal” sounds yet, or because I wasn’t doing the exam properly and having the patient breathe deeply enough to elicit these sounds. I definitely need more practice in order to make sure I’m recognizing anything outside of normal limits.

 

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?

I think I need to focus on not rushing through the history taking or the exams. Sometimes, as a student, I feel burdensome to the patient by asking them to answer questions or perform physical exams on them that they’ve already had to go through. This has led to me forgetting to ask certain questions during the history and then having to circle back and ask after I remembered them later. It would be better for my ability to organize my thoughts if I learn to relax more and ask the pertinent questions as more information is elicited. I will also make a point to speak with more confidence about what I’m performing and why I’m performing it, now that I feel I have more knowledge of pathologies and diseases under my belt.