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

I went into more detail for the last H&P because my patient had more issues and I was seeing him in the Pre-Admission Testing site, so I wanted to cover any issues he had that could possibly interfere with his upcoming surgery. Therefore, the HPI was longer in my last note, but I now realize that I unnecessarily included information (like his chronic rash) that could’ve been left out of the HPI and just mentioned in the ROS. In my first hospital encounter, my patient had one major complaint (back pain), and I knew to only include pertinent things in the HPI because I was seeing him in the emergency department. However, I did miss some important things in the first H&P, which I will discuss in #2 below.

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

My history-taking has improved in that I am more comfortable with formulating differential diagnoses in my head and asking questions based on etiologies I am considering. In my first encounter, my patient was in the ED and complained of back pain. Unfortunately, I failed to ask him if he had experienced any bladder/bowel incontinence, saddle anesthesia, or other red flag symptoms that may suggest cauda equina syndrome. This was because I had “tunnel vision” and only thought of musculoskeletal back pain and aortic dissection.

• In what ways has writing an HPI improved?

I have been comfortable with writing HPIs for a while now because I previously worked as a scribe before starting PA school. So although there has not been a drastic change in the HPIs over the semester, I can say that I feel even more comfortable and smooth in writing them in the more comprehensive manner that this program requires.

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

Although we have only gone to the hospital 3 times this semester, I feel as though I am WAY more comfortable with performing a physical exam (PE) than I was the first time around. Of course, I would still say that I am not very skilled yet with PEs, but I am looking forward to having this part of the patient encounter feel more natural over time. I feel strongest about the abdominal exam. I feel weakest with the fundoscopic exam because I still cannot visualize important structures of most eyes that I look in. I also feel weak in the cardiac exams because I think I need to become skilled at distinguishing normal from abnormal heart sounds.

• 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 plan to focus particularly on the cardiac exam so that I can reach a point where I listen to a murmur and can confidently say what type of murmur I hear. This is mostly because I’m interested in the cardiology and emergency medicine specialties. I also would like to target my skill in taking a sexual history because I think my confidence in this part of the interview needs improvement in order to make future patients feel comfortable.