- What difference do you note between the two H&Ps?
- The first thing I noticed between both H&P I did not complete all OLCARTS. Neither did I spend time digging deep into the patient’s PMHx. Also on my first H&P I didn’t know what happens when the patient has an allergic reaction. The second thing I noticed is that I didn’t have much experience in performing a physical exam or was comfortable, and didn’t get to do a full thorough physical exam like I was able to perform for my 3rd H&P.
- In what ways has your history-taking improved? Are you eliciting all the important information?
- Personally, I do feel like my history-taking has improved. In my first H&P I tried to get all the details, and a lot of it was irrelevant. By my final H&P for the semester, I had a system in place that allowed me to feel more natural than robotic. During my first visit, I had a paper to help me get through all the H&P and by my last visit I was able to get through them without relying too much on my sheet
- In what ways has writing an HPI improved?
- I’m now more comfortable, and able to get through all of OLDCARTS. In my first H&P I forgot to ask certain questions from OLDCARTS. I also didn’t go into detail about how the patient was stabilized by the ED as the patient was admitted to internal services when I interviewed her. I didn’t go into detail about her sexual orientation, or ask her about her previous occupation all I put was retired, and as we have learned certain occupations can expose a patient to certain illnesses. In my last H&P, I asked more detailed questions about ROS such as last dental exam, last eye exam, and last colonoscopy exam, which I didn’t do in my first H&P.
- 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 comfortable performing physical exams. I worked as a scribe in the ED and saw physical exams being performed. Even though at first it was nerve-wrecking performing a physical exam by myself with no supervision since I was worried I would make the patient uncomfortable, once I got into the exam I felt comfortable and took my time. One area that I can improve on is that I don’t have a system in place I jump around. I would listen to the heart then I would perform an exam of the abdomen when it would make more sense to perform a lung exam and heart exam at the same time.
- 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?
- Before starting my clinical year, I would like to get better at identifying what is abnormal from normal. I don’t feel like I’ve heard enough heart sounds to tell the difference between the different types of murmurs or a murmur in general. Another area I would like to improve on is getting more pertinent positives when I’m going through ROS. At times I would just check it off, but not ask more questions which can help in narrowing my differential diagnosis.
