H&P Reflection

1. What differences do you note between the two H&P’s?

I chose two H&P’s from my internal medicine visits so that I can most accurately compare the two, each taken in a similar environment. One main difference I note between the two H&P’s is that my most recent H&P’S HPI has a better flow to it and is more focused in that it more clearly demonstrates the relationship between the patient’s chief complaint and the other information I was provided with such as what the patient was doing before the symptoms began, past or present medical history and the other associated symptoms and how all of that information relates back to the complaint. In the same vein, I also feel that I was able to include the most pertinent positives and negatives which related to the chief complaint to narrow down the differentials as opposed to including all of the information I asked about. Lastly, I feel that I wrote my most recent HPI unique to the patient and his presentation and veered from the template in order to best adequately depict his situation instead of following the provided H&P template sentence for sentence like I did in the first, possibly leaving out important information

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

I find that my history taken has improved in that I’m more comfortable and better able to ask the patient pertinent questions to their chief complaint and other medical and social history as I’m more familiar with differential diagnoses and how certain symptoms and history relate to them. In my first H&P, I was much less familiar with forming differentials and so I would waste time asking less important questions instead of more focused ones to elicit information which would narrow my differential list. I still have ways to go in forming differentials, but I definitely feel that I have improved in this area. I believe that I am eliciting most of the important information but similar to my previous point, due to a lack of expertise in creating an appropriate differential list, I think that I may miss eliciting some important information due to a lack of knowledge that that piece of information could lead me to closer to a likely differential.  

3. In what ways has writing an HPI improved?

I find that writing an HPI has improved in that I’m now more aware of the most pertinent information and how to best include it so that the HPI will have a flow to it and be best understood by the attending. I used to write an HPI with the mindset of simply stating the information and as long as all of it was present, it was sufficient. Now, I make a greater attempt to adequately paint a picture of the patient so that anyone reading the HPI will get a clear idea of the complaint and how it relates to their history.

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

I feel that I definitely need work and practice in performing a physical exam but I also feel confident in what I’ve learnt and the techniques that I’ve used in completing one up until now. I feel strongest about the performing the pelvic, breast, bimanual and rectal exams. It’s possible that since we learnt that most recently, in Spring semester, I feel most comfortable with it but I do feel that I practiced those areas a lot and well. Additionally, since we just took OBGYN I feel those areas have been reinforced and retaught since Physical Diagnosis I. feel weakest about the abdomen, mainly because there are many exams and special tests with various techniques to complete within it and so I feel that I could use more practice with this area.

5. Which of the specific areas will you target as needing particular focus in future patient visits when you start the clinical year?

While there are a few areas I want to work on, there are two in specific that I will target when starting the clinical year. One is trying to create differentials as I elicit the patient’s history both in the HPI and their other history. While I find definite improvement in this area from when I started hospital visits, simply by learning in class and especially from clinical correlations this past semester, I hope with more work, time and practice I will become more proficient in creating a focused differential list. The other area I want to focus on is in terms of time, being able to forego the less pertinent ROS and physical exam and be able to hone in on the most pertinent ones to lead me closer to a diagnosis. This includes practicing the physical exam so it can be performed in a timely yet skillful fashion.