Now that fourth-year is almost done, I’ve had some time to reflect on my education so far. This actually happened while I was perusing through one of my old anatomy books. I came across a page where I had randomly written a giant HPI with a colossal review of systems. I had clearly been trying to commit to memory a laundry list of questions to ask our fake patients (for the first-year doctoring course).
It amazes me how far I’ve come in my clinical training. Just three years ago, I was worried about asking all of the questions for the “proper” HPI. Now that is essentially second nature to me! In fact, I almost find myself asking HPI type questions casually when I’m talking with people. Back when I was MS1 I was more worried about the mechanics of an HPI, now I find myself actively thinking about differentials during the interview and I try to structure my review of systems to ask for those questions.
Back in the day, an HPI would take me nearly an hour to complete, because I worried that I was going to miss some tiny detail. Though details are necessary, I don’t find myself asking every patient to go through their diet. I definitely feel like I’ve made significant progress! Now whenever I leave a patients room, I find myself thinking on the spot about my top three differentials.
I know it sounds cliche, but it definitely rings true: TRUST THE PROCESS.