After reviewing the H&P from the fall 2017 semester and the H&P from the spring 2018 semester, I noticed that I was more specific when describing pain. For example, I did not localize the back pain in the first H&P. In the second H&P, I went into detail about where the pain was, the intensity, whether the pain was gradual or constant, and described the pain over the years to justify why the patient had to get a knee replacement. My history taking was more thorough, which made the cases easier to follow. However, I did not include several pertinent positives and negatives in my first H&P. I would also forget to mention little details like both arms and two positions when taking blood pressure. Overall, my second H&P was more complete in including these little details. As for the assessment and plan portion, I learned to list the problem list in order of severity. In my first H&P, I listed these things in bullet form.

Right now, I feel like I have a good grasp of what to write in my HPI. I feel comfortable taking and documenting past medical history, family history, surgical history, allergies, social history, ROS, physical exam, and assessment. The areas that need improvement are the differential diagnosis and plan. Coming up with differential diagnoses and ranking them still prove to be challenging. In addition, plan is challenging as well since we have not learned all the medications yet. For example, if nausea is in the problem list, we would have to know what class of drugs to give, the dosage, route, and which nausea medication would be most suitable to the patient given their history and past illnesses.

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