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

The most obvious difference between the 2 H&Ps, was the inclusion of the differential diagnosis, assessment & plan, along with the rest of the physical examinations (which were not covered until PD 2). In my first H&P, I missed out on a few elements in my HPI from OLDCARTS. Like what prompted the ear pain, and if the pain was constant. My grammar and punctuation were also off in the 1st H&P. Between the two H&Ps, I’ve added more parts to the physical exam section since, in the 1st H&P, I only did the Skin & Head examination. As I gained more skills, I included general survey, skin & head, eye, ear/nose/sinus, mouth/pharynx/neck/thyroid, thorax & lungs, cardiac, and abdominal examination in my last H&P. Also, I started building in differential diagnosis to my H&P. 

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

When I first started history taking, I asked questions about everything. Including things that were not relevant in fear of missing out on information. Now, I think about what’s relevant and inquire about that. I’ve also gotten better at remembering to ask about applicable screening tests like Colonoscopy or Mammography. Furthermore, in my initial patient encounter, I first shied away from asking about the patient’s sexual history. Now I’m more experienced and I no longer shy away from asking about sexual history.

• In what ways has writing an HPI improved?

I’ve improved at ordering the HPI more chronologically and cohesively. I got better at sorting out information that’s relevant to the chief complaint, like pertinent positives and pertinent negatives along with medications. However, I still have moments where I’m unsure about what is pertinent to the chief complaint. I remember to ask about all of OLD CARTS, including aggravating and alleviating symptoms. In family history, I try to include more than just the parental history. For instance, I’ll also ask about the family history of paternal and maternal grandparents, siblings, and children.  

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

If I had to assess my current skills in performing physical exams, I would say I still need a lot of practice. In the hospital, I haven’t had much time to practice with a lot of patients, but I’m pretty confident in doing the basics like general survey, skin & head examination, and inspection of the thorax, abdomen, mouth, neck, etc. Nevertheless, I definitely could use more exposure to cardiac, lung, and abdominal sounds. Such as listening to cardiac murmurs, carotid bruits, abdominal aortic bruits, friction rubs, etc. I am probably the weakest at rectal, prostate, or GYN exams since I still haven’t had a chance to practice on a real patient yet.  

• 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? 

Definitely, before starting clinical year I hope to get better with timing. Right now, I have the privilege of spending more than 15 minutes with a patient just to take down their history. But I know once clinical year comes, I won’t be able to do that. So I hope to get better at sharpening my history-taking skills. With regards to performing a physical examination, right now I need to remind myself of what tests to perform in the different organ systems. With more practice, I know I’ll eventually gain procedural memory. I also need to work on being more familiar with cardiac murmurs and adventitious sounds in the lungs, along with the abdomen. Right now, I’m still struggling to identify systolic and diastolic murmurs. I’m also working on getting better at reading and interpreting EKGs.