H&P – From Physical Diagnosis I

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H&P Final – From Physical Diagnosis II

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Reflection:

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

The differences evident between the two H&Ps I chose to publish on my portfolio reflect a great amount of learning and personal growth. Immediately evident is the fact that I learned to be more concise when writing an HPI, including the appropriate, pertinent information. Additionally, I improved in reporting physical exam findings properly. For example, in my H&P from Physical Diagnosis I, under the physical exam findings for the Thorax and Lung exam, I simply wrote “no adventitious sounds.” In my H&P from Physical Diagnosis II, after having received constructive feedback from Professor Persaud, I was sure to document the Thorax and Lung exam properly by writing out the absence of specific findings like wheezing, crackles, rales, rhonchi, etc. Of consideration is the fact that in the H&P from Physical Diagnosis II, we had not only completed more of the physical exam (thus warranting a complete H&P), but also had a brief introduction to documenting Assessment and Plan and justifying our differential diagnoses.

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

My history taking has improved in that I’m becoming more comfortable in asking important questions. Initially, I was rather reserved in asking questions related to what may be considered more sensitive topics such as taking the sexual history and inquiring about related OB/GYN/genitourinary complaints. However, throughout my experience of several hospital visits and taking H&Ps, I have become more comfortable asking these questions, which has also seemingly led to improved patient comfort. One area in which I need to continue growing in is asking follow-up questions when encountering positive findings during the Review of Systems. Sometimes I find that I am focused on the patient’s chief complaint and that other, sometimes seemingly unassociated findings, are overlooked. I am striving to improve my history-taking such that I do elicit all the important information, though I feel I am not very far off.

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

To briefly reiterate, my HPI-writing has improved in that I’ve learned to be more concise. Additionally, constructive criticism on my earlier HPIs revealed that the elements of mnemonic “OLDCARTs,” though mostly present, were often scattered, at times making the HPI confusing for the reader. My later HPIs have improved in this domain. Additionally, I have improved in including the appropriate pertinent positive and negative findings, though I do feel that continued improvement is warranted.

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

Currently, for a first year PA student, I am confident in my physical exam skills. I feel strongest about areas such as the lung exam, abdominal exam, musculoskeletal, peripheral vascular, and neurologic exams. Additionally, I feel accomplished in that I can visualize structures when performing a funduscopic exam. Examinations I feel weakest about include the cardiovascular exam mostly due to the fact that I have yet to hear abnormal/adventitious sounds in vivo. Additionally, I feel weak about performing the rectal exam, prostate exam, breast exam, and GYN exam. This is largely due to the fact that I have yet to perform these exams on patients.

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?

Some areas that I will target as needing particular focus in future patient visits during my clinical year include the above exams that I feel weak about (cardiovascular, rectal, prostate, breast, GYN exam – by taking any and all available opportunities to perform these exams when necessary), developing a differential diagnosis, and building a rapport with my patients to obtain the full history. Additionally, I will need to continue to practice the complete physical exam so that I can complete it swiftly and efficiently. Though briefly touching upon it in our Physical Diagnosis II class, learning about which directed physical exams are warranted for what signs and symptoms will also be a particular focus of mine. I believe that improvement in these domains will occur as a result of practice in addition to increased confidence in establishing a professional identity. I am excited for the opportunity that the clinical year will give myself and the other students to improve our skills and learn about the exciting ways in which our knowledge is applied as a Physician Assistant.