H&P 1

H&P 4

1. What differences do you note between the two H&Ps?
   • The first thing I notice between the 2 H&Ps is that my writing has become more concise. This is especially apparent in the HPI section where I elicited more pertinent information in a more organized and brief manner. I also notice that my findings are more accurately recorded in all of the history sections, especially the medical and medication histories.
2. In what ways has your history-taking improved?  Are you eliciting all the important information?
   • I think the most notable way that my history taking has improved is by becoming more comfortable and confident asking the patient questions, and knowing which questions to ask. At first I was too focused on the chief complaint and I would ask specific questions, as I grew more comfortable taking histories I started to ask more open-ended questions which allowed the patient to give more information and made history taking more of a conversation and less of an interview.       Asking more open questions at first and following them up with specific questions allows me to elicit as much important information as possible. The one specific part that I did not elicit in my more recent H&P was how the patient’s spermatocele was diagnosed. He told me it was diagnosed by his urologist, however I did not ask if it was via biopsy or US. This information would have made my history more complete.
3. In what ways has writing an HPI improved? (hint: look at the rubric scores)
   • My rubric score for both H&Ps was unchanged, however I believe that my HPI writing has improved because I am able to deliver more important information in a more organized and concise manner. In my earlier HPI I added some findings that are more appropriate in other sections of the history (such as ROS), in my more recent HPI I had all information in appropriate sections.
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 confident in many sections of the physical exam such as skin, ears, lungs, and abdomen. For the heart exam I am confident in my technique however I am still uncomfortable identifying murmurs because I don’t have enough experience hearing them in a patient. I don’t feel confident in the eye exam, specifically with fundoscopy. I have difficulty visualizing the structures within the eye, and need to do more work and get more comfortable with the technique.
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 think I need to focus on being more confident in my physical exam skills. I know that with more practice performing these techniques, I will be better at identifying abnormal findings and I will be more confident with my exam. I also believe that I need more practice with the doing the full physical exam together, beyond just the portions that I am uncomfortable with. Practicing the entire exam at one time will allow me to be more confident in my technique and more efficient when evaluating patients.

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