What differences do you note between the two H&Ps?
The biggest difference I noticed between my first and last H&Ps was that my last H&P had a much smoother flow that developed over the two semesters. This is particularly evident in the HPI, showing how I have become more comfortable in my own writing style.
In what ways has your history-taking improved? Are you eliciting all the important information?
Though my history taking has improved as I demonstrate a greater familiarity with what follow-up questions need to be asked, having patients that needed the assistance of an interpreter showed me that I need to be as specific as possible when looking to get relevant information on my patients. I feel that I was able to better formulate follow-up questions for both pertinent positives and negatives with my last visit of the semester. I think this comes additionally with having more time in the classroom and understanding how to dig a little deeper.
In what ways has writing an HPI improved
The main difference I noticed was the improved fluidity. During my first visit, I felt extremely apprehensive about asking my patient “too many questions,” and I may have missed some important information. By the time I had my final visit, I felt much more comfortable approaching a stranger and getting all of the relevant information to help them in the best way that I could.
What is your self-assessment of your current skill in performing a physical exam? Which areas do you feel strongest about/weakest about?
I feel very confident about performing a physical exam of what we have learned up to this point. I would still like to improve in the speed of my physical exam, which is where I feel I have the most room to grow. Right now as I go through each system I find myself stopping to run down a checklist in my head to make sure I have not missed any aspect of each exam. Overall, I feel I am strongest in my technique in making patients feel comfortable when I approach them for an exam.
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?
My biggest area would be to continue taking a full history and doing a review of systems. If you listen to what a patient tells you, they can often tell you exactly what is wrong before you even begin a physical exam. I am very comfortable with speaking to patients, but knowing how to keep a medical conversation flowing is a skill that I am looking forward to working on in the fall and as we move closer to our clinical year.