Reflection
More pertinent positives are included and explained in HPI. In physical examination part, more abnormal findings are listed and described in each body system. In addition, assessment, plan, differential diagnosis parts are added. Plan of H&P for the patient has more details and clinical reasoning. Differential diagnosis has listed from most likely diagnosis to less likely diagnosis. And also, each differential includes reasons why I think it will be the diagnosis and what lab tests or images study can rule it out. When interviewing patients, show respect and understanding, use more open-ended questions during the interview to encourage the patient to express his or her concerns and feelings freely first, and know when to use close-ended questions to clarify. Sometimes, patient can be very talkative, and talk about things that are not related. I learned how to re-direct patient back to track and asks more about current complaints. After talking to patient, repeat back important points so that patient can correct if there are any misunderstandings. At beginning, the HPI is more like listing each step of OLDCARTS. But, now, it includes more details of OLDCARTS, more like a continuous story of the patient’s chief complaint, like the setting of the complaint and any prior episodes and progress of the complaint. In addition, at the end of paragraph, additional pertinent negatives and positives are provided which may explain the patient’s presenting chief complaint. Pertinent negatives also help with differential diagnosis as well.
Basically, I can do the head to toe exam thoroughly, but may need more time to finish the whole exam. Sometimes, little points will be missed, and it is easier for me to do the exam when the patient has specific complaints. I feel very confident to do exams of upper and lower extremities, like range of motion, strength and special tests. The weakest areas will be percussion, and I am bad at determining grading levels. For example, grading pulse and grading pitting edema, it is hard for me to know what increased pulse and bounding pulse are feel like, and what should be described as slightly pitting and deeper edema. When start the clinical year, I hope I get to know when is head to toe exam necessary and when to perform specific part of physical exams only according to patient’s complaints. In addition, I want to learn more about treatment plan.
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