The following paper is a personal reflection on my 1st and 3rd History & Physical that I have performed for Physical Diagnosis I:
What differences do you note between the two H&Ps?
The formatting of my Chief Complaint and History of Present Illness has improved from my 1st to 3rd H&P. The social history section has become more detailed as a result of me asking more specific questions to get a better overall picture of the patient’s social factors. I was able to perform the heart, lung, and abdominal exam on the 3rd H&P which I had not yet learned for the first one.
In what ways has your history-taking improved? Are you eliciting all the important information?
I have become more familiar and comfortable eliciting OLDCARTS which has helped gather the most important information regarding the patient’s symptoms and present illness. I have also improved upon asking follow-up questions that are more pertinent/relevant to the current clinical picture than I had in the first history-taking. Learning to rephrase certain questions or medical terminology in a way that the patient better understands has been one of my biggest advancements since my first history-taking.
In what ways has writing an HPI improved? (hint: look at the rubric scores)
The formatting for my first HPI had several errors in it which have been corrected for my 3rd HPI. I have learned to place the patient’s pertinent medical illnesses in the first line of the HPI along with their COVID-19 status. I am also now adding the pertinent negatives and positives from the ROS in the last line of my HPI. The 1st HPI contained information that belonged in other parts of the SOAP note such as the PMHx and had extraneous information included. For the 3rd, I corrected these errors by trying to make the HPI more focused with no “content-less” phrases.
What is your self-assessment of your current skill in performing a physical exam? Which areas do you feel strongest about/weakest about?
Overall, I feel I am doing well performing the physical exam for my current education level. I feel equally strong about the ear, abdominal, heart, & lung exams. I feel confident in my techniques and findings for each of those areas. I feel weakest about the fundoscopy portion of the eye exam due to my difficulty appreciating the microvasculature & structures. I feel comfortable with my technique and knowledge of what I am looking for but need more practice to feel confident that I did not overlook a visible abnormality.
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?
When I start my clinical year, I would like to specifically focus on improving my physical exam section the most. As previously mentioned, I would like to become more comfortable with the fundoscopy exam. I also would like to improve my speed and flow. The physical exam has been the section I have missed the most information in which has been due to a mix of time constraints, patient comfortability, and not having yet learned some parts of the exam (ex: neuro). I believe that sharpening my physical exam skills will be of great value when ruling in or out diagnoses on my differential.