The following paper is a personal reflection on my 1st and 3rd History & Physical that I have performed for Physical Diagnosis II:
What differences do you note between the two H&Ps?
The assessment and plan were incorporated this semester. My first H&P reflects my limited knowledge at that time of how to address this part of the note. It was missing some of the patient’s past medical problems and not all the parts listed in the assessment were included in the plan. In my last H&P, the assessment was a statement that listed all the patient’s past medical problems along with the abnormal findings from that visit. The plan included each problem mentioned.
In what ways has your history-taking improved? Are you eliciting all the important information?
Eliciting OLDCARTS has become “second-nature”. Initially, I had to write out the acronym ahead of time and now I can obtain the information needed for it without hesitation. I have also become more comfortable with exploring more pertinent parts of the history and filtering out parts which may not warrant as much attention based on the clinical scenario.
In what ways has writing an HPI improved?
The first HPI had some disorganization regarding the initial and last sentences. The last H&P become more concise with information that was only relative to that visit. Initially, I was included a lot of information that should have been reserved for the past medical history. In summary, my overall understanding of the organization, flow, and components of the HPI has improved.
What is your self-assessment of your current skill in performing a physical exam? Which areas do you feel strongest about/weakest about?
At the beginning of this semester, I had not yet learned ~50% of the physical exam, which made completing a physical on patients challenging if they had complaints that required a physical workup in the areas, I lacked knowledge in. By mid-semester we had covered all the remainder areas of the exam which booster my competence and confidence for my last patient encounter. I have now filled in my knowledge gaps and can tie it all together. My biggest weakness is recalling the mental state exam, which I plan to work on, but will also be printing out copies of the exam for the clinical phase.
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 am going to specifically target working on the mental state exam, mini-mental state exam. I performed well on these areas during the examination period, but I am finding myself forgetting certain aspects since a lot of it is verbalizing/patient question based rather than muscle memory or something I can easily link pathophysiology to in my mind. I plan to brush up on this area during winter break and especially before and during my psychiatric rotation.