H&P Self Reflection

1) I see incredible improvement from my first H&P of first semester to my first H&P from second semester. The biggest change I noticed was in the HPI. I mastered the HPI portion, which was a huge mess on my first one.I learned how to organize my thoughts beforehand so that my HPI is much more organized and clear. I also made a greater effort to write with neater handwriting, and made sure to include all the important information throughout the H&P.

2) My history taking has definitely improved, as OLDCARTS has become almost second nature to me, and it is much easier and more natural for me to ask the correct and pertinent questions from the patient, in order to elicit all the important information. I also learned the best way to ask the specific questions to the patient, so that I they understand what I am asking and explain themselves well, and I can get the information that I need. Furthermore, in the beginning I would often forget some aspects of the history, but as I practice I am able to remember more and more of it offhand.

3) As I mentioned in question 1, my HPI writing has improved drastically, both in content and in organization. Firstly, in my first H&P, I did not include all of the parts of OLDCARTS in my HPI, so I was missing important content that needed to be there. I also was often not specific enough with my descriptions, such as writing about pain without specifying which side of the body. Furthermore, since I did not organize my thoughts beforehand, my writing style was not so great, and I wrote extra unnecessary information, and also phrased information in weird ways. I definitely improved all of these aspects of the HPI, by practicing with OLDCARTS and learning how to make my findings more specific (including the first step- making sure to elicit specific and complete information from the patient), and learned to write out the HPI beforehand so I can organize my thoughts better and make it sound coherent and eloquent.

4) Unfortunately, we have not had the opportunity to perform actual physical exams in a while, so this question is a little difficult for me to answer. Generally though, I felt like my physical exam skills were okay but could really use some work. Fundoscopy was particularly difficult for me, as was the oral exam since it felt invasive to go into patient’s mouths. Heart, lungs, and abdomen were sometimes easier and sometimes harder depending on the patient, his build, his comfort with me examining him etc.

5) I think the actual physical exam portion will be the most important for me to work on in future patient visits. I definitely need work all around, but the HPI we were able to get more practice with in clinical correlations which was good. Another area which I would like to focus on more is figuring out which part of the ROS is relevant to my patient’s concerns, coming up with pertinent positives and negatives, and coming up with differential diagnoses, which I have trouble with.