Reflection on H&P’s

 

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

 

The difference between the two H& P’s was that my first one during fall semester 2018’ was from a patient encounter I had during pre-admission testing, while the second one was from spring semester 19’ a patient encounter I had in the emergency department. Because of this, there are some differences in the level of detail I was able to obtain in obtaining HPI from the patients alongside the differences I have due to experience writing H & P’s. I was more detailed in explaining the patient’s symptoms in the second H& P then I was in the first.

 

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

 

I believe that I have improved on eliciting more of the patients subjective feelings about their symptoms the more cases I have encountered. I try to get as much of the patients words so that when I’m writing the H & P, it can sound more unique to the patient and hopefully help in developing differential dx’s that are accurate. I also have made efforts in gathering more detailed PMH about the patient, including the dates of specific screening tests, and trying my best effort to gather as much family medical history.

 

3. In what ways has writing an HPI improved? (hint: look at the rubric scores)

 

I think I have improved on gathering most to all of the elements in OLD CARTS when writing my HPI. I have developed a better method in writing the history so that it is orderly and includes the relevant information like precipitating factors, as well as alleviating/exacerbating factors. I have gotten better at addressing the pertinent positives in my HPI and expanding on Important ROS findings in my HPI.

 

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

 

My self – assessment in performing a physical exam is that I am overall above average to good. I feel like I have a good understanding on what to perform and the significance of each exam. However I feel like I can improve on some of the more technical aspects of the physical exams like eliciting reflexes for example. I definitely want to improve on fundoscopy in visualizing the fundus. I feel like I can improve on the speed and flow of performing each exam but I feel that I will improve with more experience. I also want to spend more time developing a focused physical exam. I think I am stronger in performing abdominal, eyes, ENT, and musculoskeletal exams.

 

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 want to particularly focus on improving on fundoscopy, skin, hair and nails, abdomen, cardiac, lungs, peripheral vascular and cranial nerves exams. I chose these particular areas because I feel like there is so much that can be understood about a patient’s symptom from these exams. I want to improve on auscultation for murmurs, bruits and bowel sounds.