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

In the two different H & Ps I note that there is a tremendous amount of knowledge that I have learned over the past year. I also note the second semester, I had a clearer understanding of what should and should not be included in my HPI and so it was more clear and directed than the first. I also see from the grading aspect that I began to learn how to write my findings in a more appropriate organized and ordered fashion and received comments on that skill.

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

Over the past two semesters I believe that my skills of history-taking have greatly improved. The first time I took a history I was so nervous to collect as much information that I did not elicit all the information I could have gained from the patient that would be more specific to her chief complaint. However, after the practice and experience of going to the hospital I feel that I have a greater ability to recognize areas of the history that may seem disconnected at first but would actually help to rule in or out a diagnosis. This is another area where I feel I have improved. While at the beginning of the year we may not have been aware of the various diseases and the symptoms they would cause by this past semester I felt like I had much greater knowledge when it came to diagnosing. Through this knowledge I was able to have differential diagnoses in my head as I asked the history. Therefore, I was able to ask the relevant questions and make sure that I was getting all the important information from the patient

3. In what ways has writing an HPI improved?

My HPI has improved in many ways over the past year. In my first HPI that I wrote I think my use of OLD CARTS was not as strong and detailed as it should have been. Additionally, I feel that perhaps I didn’t provide all the necessary information that would help determine a potential diagnosis. In the most recent HPI I had an easier time in recognizing how the HPI should be formatted and believe that I provided more information that could help distinguish the cause of the symptoms.

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 think one area that I feel I am able to succeed in is that I am able to make the patient feel comfortable throughout the process of the physical exam. One time after I completed the physical exam the patient remarked that he felt that I treated him with respect and care and was very appreciative with the way I interacted with him. I believe through this comfort the patient is able to relax and is more open to having a full physical exam. One of the areas that I feel the weakest about is the fundoscopy. I feel that I need more practice in being able to view the cup to disk ratio and I would like to become better at it as the patient may be irritated by the bright light.

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 after learning all the information this semester in Physical Diagnosis, I feel that I am sometimes rushed by the amount of time allotted to us when examining the patient. In the future I will try to make sure that I am able to think about the differential diagnosis faster and therefore ask the specific questions needed for the patient as well as examine the patient in the proper time. Additionally, I hope that I will work on my funduscopic skills so that I am able to perform an eye exam without irritating the patient.