HPI Reflection:

What differences do you note between the two H&Ps?
I noticed that I was better aware of what goes in each section for the write up. For example, in the beginning, I thought it was important to include all medications in the HPI, but then I learned that it is only pertinent medications that may contribute to the chief complaint, or if they are non-adherent. Additionally, I made sure to note whether there were any recent traumas or falls in the HPI, as it was an important aspect for the chief complaint.

In what ways has your history-taking improved? Are you eliciting all the important information?
My history-taking improved as I was able to effectively elicit all the pertinent information. I made sure to cover all of OLDCARTS. I also made sure to ask the patients to elaborate on exactly what they were doing before their injury. I was also better at asking for the dosages for their medications.

In what ways has writing an HPI improved? (hint: look at the rubric scores)
I believe that I have a better flow in my HPIs. I make sure to include OLDCARTS in an organized fashion, but with enough detail to fully encompass the encounter. For example, instead of just writing pain in the left leg, I make sure to describe exactly where the pain is (calf, thigh, etc).

What is your self-assessment of your current skill in performing a physical exam? Which areas do you feel strongest about/weakest about?
I am much more confident in performing a physical exam now. I feel very comfortable taking vitals. I feel confident about abdominal exams as well as all the special tests. However, it sometimes seems difficult to actually be able to identify an abnormality such as a murmur during the heart/lungs exam.

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 I need to focus the most on actually trying to converse with the patient rather than being focused on only getting the important information down from a checklist. I want to be able to remember and ask the right questions without referring back to a checklist. This would make the patient encounter more fruitful, and feel like I am more present in the moment. I would also like to get more comfortable performing the physical exam for heart and lungs.