Physical Diagnosis allowed me to learn the skillset of the physical exam but also to hone my skillset of taking a history and writing a medical note.  Prior to my role as a PA student, I worked as a medical clinical information manager, where I was required to write and complete the provider’s medical note for each patient seen in practice.  It is a very different experience when you are the one taking the history and writing up your own medical note.  In evaluating my H&Ps from PD 1 and PD 2, I found that I was more concise with my approach to writing up the HPI.  In my PD II H&P, my assessment and plan was much stronger and I believe I did a better job of articulating what should happen next, which I would attribute to a better understanding of practical medicine.

With the progression to PD 2, I found that I was more confident in my questioning and that improved my history taking.  During PD 2, I was assigned patients that were not as happy to speak with a student, which required me to be on point with my questioning and forced me to complete portions of the exam while I was asking questions about the patients history.  Walking in to the ED, I wasn’t sure I had that ability but I was pleasantly surprised I was able to complete the exam and obtained all of the information I needed to write up a solid H&P.  I was able to elicit the information I needed and maintain a strong relationship with the patient.  Of course, as I learn more, this skill will continue to evolve and I look forward to the time when I won’t need any prompting from our H&P guidelines.

I find HPI writing to be somewhat subjective based on the provider.  My HPI writing has definitely improved with practice, albeit I came into the program having written medical notes for a year prior.  I believe my HPI’s are stronger in their ability to tell a persons history thoughtfully and concisely.  I find I am able to articulate why a patient presents to the ED (hospital) and highlight the relevant supporting information that will help all providers deliver the highest level of care, without having to duplicate lines of questioning. Knowingly, medical writing is different than writing in any other fashion and I worked hard to make my HPIs as succinct as possible.  I think I was able to improve upon that from first semester to second semester.  I also believe I did a better job at organizing the patient’s story, while still including all relevant information as the semesters progressed.

I have a strong understanding of the basic skills required to complete and perform a physical exam.  I am confident in my ability and would like to continue practicing and utilizing this knowledge as I continue my studies.  I look forward to the day where this becomes second nature and is not a ‘check-list’ in my mind.  I believe this will come with practice and time spent with patients but I want to ensure when I begin my clinical year, I am as prepared as possible to take a full history and complete a sound physical exam.  I feel very comfortable about completing the skin and HEENT.  Given the cardiac and thoracic exam are typically completed for each patient regardless of presenting complaint, I want to ensure I am continuing to grow and evolve my skill set with these areas not from an auscultation perspective alone but also percussion and inspection.  I want to hone my skills for the Neuro/Cerebellar exam because of the important role they play with involvement in the patient’s brain function.  Lastly, I want to continue to grow my skillset as it relates to the directed exam.  I want to ensure I am capturing enough of an exam to treat the patient properly and covering all bases to provide sound medical care without extending a patient visit unnecessarily or wasting time.

As I think about future patient visits I will have during the clinical year, I want to ensure I do not jump to conclusions with a diagnosis and I take all presenting information into consideration when forming a differential diagnosis.  I want to be very aware of that fact as to not get in a one-track mind and miss an important diagnosis.  I want to focus on my ability to move through an exam fluidly without breaks where I am looking something up or unsure of how to test for a particular malady.  I want to hone my skill set from a physical exam perspective and ensure I am comfortable jumping around if necessary but also thoughtful in my approach to ensuring the patient is as comfortable as possible.  I want to work on my ability to obtain all of the information I need to write an organized and thoughtful medical note, not only including all relevant information about the HPI but PMH, PFH, PSH as well.  There will definitely be times where I will need to go back and ask the patient follow up questions but with time I would like to gain the foresight and understanding of additional lines of questioning that need to be asked and proactively ask those questions in the attempts to provide the best care possible for my patients.

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