What differences do you note between the two H&Ps?
From the first H&P I wrote to the last, I noticed considerable amount of improvement. The latest H&P I wrote was more more detailed and included impertinent information. The major difference between the notes was that the last H&P included a full physical exam. In the first H&P I was only able to conduct a limited physical exam which only included HEENT, heart, lungs and abdomen. I was also able to create a better differential diagnosis which allowed me to ask the important relative questions for the ROS portion. Assessment and plan was also not included in the first H&P, but was in the last. I was able to create a list of top differentials and discuss the labs, diagnostic imaging required to rule them in or out and which diagnosis is more likely.
In what ways has your history-taking improved? Are you eliciting all the important information?
My history taking started to improve as I learned more clinical knowledge. Due to this, by taking just the history I was able to create a differential diagnosis which helped me focus more on certain areas of the physical exam. The ROS questions I asked were specific to my differential which is a skill I expect to enhance throughout my rotations. There are many patients that tend to diverge from the information that is necessary to give to a provider. I am starting to also improve on shifting the conversation back without being rude.
In what ways has writing an HPI improved? (hint: look at the rubric scores)
With practice my HPI writing has also improved. By eliciting the important information and ensuring I use OLDCARTS I am able to write the HPI as if it were a story which allows the reader to follow it easily. I avoid using repetitive words and ensure its concise yet detailed.
What is your self-assessment of your current skill in performing a physical exam? Which areas do you feel strongest about/weakest about?
Physical exam is still an area that I feel weak in. Although I have noticed improvement in my confidence level in conducting a physical exam, I still need to work on improving it further. I do not need to go through papers anymore to do a physical exam and have a chronological order that I follow. However, I still doubt myself while listening to lungs and heart sounds. This is still an area I feel the weakest about. I feel the strongest about being able to relate physical exam findings to pathologies which stems from knowing more about diseases/pathologies.
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?
Areas I feel the weakest in, is where I will focus my attention during the clinical year. For instance, in the physical exam I am not confident about examining the heart and lungs.I will target this during my clinical year. I also do not feel as comfortable in providing someone counseling on smoking cessation, suicidal ideations, safe sexual practices and asking about the sexual history. Overall, I want to become faster at interviewing and examining a patient. These are the areas that I will target during the clinical year to be better equipped as a PA-C.
