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

Compared to the first H&P, which is more fragmented and less comprehensive, the HPI in the second H&P better presents the “story” of the patient within the context of the chief complaint, rather than just the immediate presenting medical condition. It is also more focused on the pertinent details pertaining to the chief complaint with respect to the organ systems involved. The first H&P was limited in that regard, primarily involving the elements of OLDCARTS without much depth. The second H&P is also more extensive and comprehensive of the physical exam elements.

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

Since taking my first history, I have improved on focusing on the pertinent systems within the ROS when a patient presents his/her/their chief complaint. The symptoms, as they relate to the affected system(s), would increasingly come to mind as I progressed through my hospital visits, allowing me to flow through the history-taking more efficiently. I am also learning that patients’ medication lists can be quite extensive. However, it is important to thoroughly understand, as certain medications can inform past medical history, especially in cases where the patient does not disclose all elements of their past medical history, and it becomes evident later in the conversation.

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

My writing of the HPI has improved in the sense that I elicit more detailed information beyond OLDCARTS. This has helped me focus on both the pertinent positives and negatives, which aid in forming possibilities for a differential in my mind. As previously mentioned, my writing of the HPI has also improved in presenting the patient’s story rather than just the immediate chief complaint at present. It has become more representative of the patient as a whole rather than the current medical condition they present with.

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

I would say I am not fully confident in performing a thorough physical exam, as much of my time during hospital visits has been taking the history, and I have had a limited amount of contact time with patients. I need more practice and repetition, and we have yet to finish the musculoskeletal system. Whereas I feel strongest about the most of the systems from the head to the lungs, and maybe GI, I feel weakest about the cranial nerves and the cardiac exam. I could also use more practice with the otoscope and ophthalmoscope.

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?

An area in which I will focus on improvement is being more comfortable and confident in performing the physical exam. Within that, especially thinking about the clinical year, it is important that I develop consistency in conducting the physical exam so that it ultimately becomes effective, methodical, and efficient. This, I believe, will also help reinforce my presentation of the HPI when it comes to presenting any pertinent physical findings.