1. What differences do you note between the two H&Ps?
The greatest difference I noticed between my first and third H&P was the speed and comfort at which I was able to perform the task. For my first H&P, I asked the patient questions in a scattered manner. I tried to recall points made in class and performed them in a checklist-like manner. When writing the HPI, I also spent more time mulling over what was pertinent information to include. By the third H&P, I became more proficient in asking patient questions. My questions became more organized so that speaking with the patient felt more like a conversation rather than a checklist. Writing the HPI also became more fluid as I repeated the process several times throughout the semester.
2. In what ways has your history-taking improved? Are you eliciting all the important information?
I developed a better flow of what questions should be asked to gather a comprehensive overview of the patient’s presentation. This included becoming familiar with “OLDCARTs” so that it was performed in an habitual manner. Additionally, I became more aware of asking distinct questions for situations that were atypical. Sometimes, a patient failed to provide pertinent information when asked directly about their current medical condition. By asking more personal questions, I could elicit a more detailed response that provided key information on their current situation. For example, the patient I encountered in the Emergency Department was concerned of having a cardiac complication due to low blood pressure. However, she denied ever having experienced this, had no history of cardiovascular disease, and exhibited stable vitals since arriving to the hospital. This provoked me to ask her why she was checking her blood pressure in the first place. She went on to explain that she was testing her husband’s new electronic blood pressure machine. This helped us lead to the conclusion that her low blood pressure was likely due to misuse of the new device rather than a true cardiac complication.
3. In what ways has writing an HPI improved? (hint: look at the rubric scores)
My HPI improved as I became more succinct in delivering relevant information. In my first H&P, I had trouble reviewing what information should be included in the HPI. Information I believed to be pertinent actually belonged better in the past medical or social history. The organization in writing the HPI became more clear as I repeated the process.
4. 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 much more proficient in taking vitals due to prior work experience and reinforcement during this semester. However, I still feel uncertain when performing the fundoscopy and cardiac exam. As most of classmates are healthy, my understanding of cotton wool spots, AV nicking, and heart murmurs are by textbook images and definition rather than firsthand observation. Understandably, these are very technical skills that require time, practice, and exposure to develop.
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?
I would like to become more proficient in performing the physical exam so that my methods and movements become more fluid. At the moment, portions of the physical exam still feel very mechanic as I am learning to properly utilize the tools and techniques. As mentioned above, the fundoscopy and cardiac exam are areas I need to develop. Additionally, I believe there is an art to performing the physical exam while still connecting with the patient. I would like to better consolidate the performative portion of the exam while communicating with the patient. This will create a more comfortable environment and establish a stronger provider-patient relationship. I am confident that the integration of these skills will sharpen with additional practice.
