Comparing H&P #2 and #3

 

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

H&P #2 was done for my second hospital visit. I was still confused about the amount of information that needs to be included and what is most relevant. I wanted to be thorough without overly describing simple findings and found myself missing some key terms. In my third H&P, I noticed that I focused more on what applied to the patient and the general flow of findings was much better and coherent.

 

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

The second H&P was difficult to write because my patient was not willing to discuss much with me or be examined. I was still juggling between trying to elicit as much information as I could and being respectful of the patient’s wishes. I became more confident in asking about history and obtaining more information. As I practiced more, I found myself asking more relevant questions and organizing my thoughts to cover everything in as much detail as necessary to the patient’s situation. My third H&P improved in this aspect as there weren’t any missing findings and all pertinent positives and negatives we documented. The HPI covered all the important information relating to the patients complaint while being succinct and detailed.

 

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

I’ve improved between the two H&P’s in organization and flow. My HPI got better in listing relevant information and organizing findings. Previous H&P’s showed missing details and irrelevant observations, whereas the third H&P was written much better, clearer, and including all relevant information.

 

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

Although I understand and know how to perform a physical exam, I will not deny that I need much more practice. Carrying out the physical exam in a manner that’s logical and detailed, while not wasting time on repetition, is crucial to gaining patient trust and confidence. The more I practice, the more comfortable I feel and the more smoothly I perform a physical exam. I feel strongest about the heart and lung exam. The area I feel weakest in is assessing cranial nerves as the numerous details are sometimes easily overlooked.

 

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?

The area I’ve struggled with during hospital visits was eliciting information from patients that weren’t too happy to speak to students. A lot of the time, patients experiencing pain, fear, or feeling uncomfortable in a hospital aren’t jumping at the opportunity to be interviewed by yet another person, especially if it is not someone that is directly contributing to their care. Balancing the task of obtaining information while being respectful of patient wishes is difficult, but I believe that as a clinical year student on rotations I will be more confident in performing a thorough assessment. Having much more knowledge and experience as well as being able to contribute to the patient’s care will enable me to dive deeper into history and perform more detailed exams.