History and Physical:

M

Reflection
Looking back on Physical Diagnosis I and II, I can see a clear difference in how I approach and complete a History and Physical. Early on, I was very focused on structure and making sure I didn’t forget anything. My H&Ps followed the checklist closely, mostly because at that point I didn’t always understand why certain questions or exam components mattered. I knew what I was supposed to ask or check, but not always how it fit into the bigger clinical picture.
As I learned more overall and started seeing patients more regularly, things began to click. With a better understanding of the disease processes I was looking for and the pathophysiology behind them, I started to understand the purpose behind the questions I was asking and the exams I was performing. That shift made a big difference for me. My approach became more intentional and natural flowing instead of just trying to get through a list.
One of the biggest improvements for me has been talking to patients. I feel much less awkward than I did early on, and conversations flow more naturally now. I’ve gotten better at getting the information I need without the encounter feeling stiff or scripted. Being more conversational has helped patients open up, and it’s made it easier for me to clarify symptoms and follow up on important details without it feeling forced.
During recent clinical encounters, I feel confident gathering a thorough and focused HPI. I was able to characterize the patient’s pain clearly using OLD CARTS, identify pertinent positives and negatives, and make sure to screen for red flag symptoms. I’m also more comfortable using the patient’s own words and accurately describing symptom severity, which has helped support my assessment and differential. I think one thing I still struggle is keeping my interactions conversational but still keeping the patients focused on just the information I am trying to gather from them.
In terms of the physical exam, I feel strongest with neurologic, HEENT, and abdominal exams. I’m comfortable with the flow of these exams and feel confident connecting exam findings to the patient’s presenting complaint. That said, there are still areas I want to keep improving, especially fundoscopy and certain parts of the musculoskeletal exam, as well as becoming more efficient overall.
As I continue practicing during my clinical year, my focus is on getting faster and more confident without losing the patient-centered, conversational approach I’ve developed. Overall, PD I and II gave me the foundation I needed, and I feel like I’m now at the point where I’m actually applying those skills in a meaningful way with real patients.

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