1. What differences do you note between the two H&Ps?
When reading between both H&Ps the first main difference I notice is that the first HPI lacks the same level of detail as the second. The second one includes character, location and radiation of symptoms whereas the first one lacks those parts of OLDCARTS. Similarly, the assessment and plan sections of the second H&P is more comprehensive than that of the first H&P. Overall the second H&P is more detailed and gives a broader understanding of the pt’s condition. This is likely due to the fact that the second H&P was completed later on in the semester and I had an opportunity to practice and develop my skills more.
2. In what ways has your history-taking improved? Are you eliciting all the important information?
Between the two H&Ps my ability to obtain a proper history definitely improved. I think this is mainly attributed to the fact that I became less afraid of asking the pt questions. Meaning, I stopped being scared of asking the pt possibly uncomfortable questions if those types of questions were necessary in order to write a proper H&P with all the pertinent information. I also think that my thoughts became more organized over time and I began to know what should be asked for each individual patient and how to follow up each question in order to elicit all details from the pt.
3. In what ways has writing an HPI improved?
With experience my HPI writing skills has improved in that I got better at ensuring to include all sections of OLDCARTS. I also got better at making the information flow into each other more. Over time my HPIs have gotten stronger, giving all pertinent information in an easy to read manner.
4. What is your self-assessment of your current skill in performing a physical exam? Which areas do you feel strongest about/weakest about?
As with everything, performing a physical exam is a skill that takes practice. I noticed that compared to my very first hospital visit, I was much more confident when doing a physical exam at my last visit. I think this confidence came because of the fact that I was more comfortable with the organization and the methods of the exam. I felt much more prepared to interact with the patient and examine them. Based on this logic, I feel that I am most proficient in the areas of the exam that we learned last semester as I have had more time to practice those parts. I feel less confident with the newer exams, and look forward to be able to practice them over rotations and feel stronger in those areas as well.
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?
As I begin rotations I hope to continue growing in my ability to stay organized in my thoughts and actions which will enable me to continue obtaining detailed, pertinent histories and write well-written HPIs. This characteristic, of being calm and organized, will also enable me to continue coming up with proper differential diagnosis lists, assessments and plans. In the medical field it is easy to lose composure and get stressed out, especially in high acuity areas, but my goal is to maintain my calm and logical thinking to ensure I provide the best care to patients.
