This boils down to practice. Of course you suck at it, how many times have you done it? I think, as medical students, we're fairly used to picking up academic concepts and memorizing crap with amazing results; however, communicating with other humans, especially sick, demented, delusional, sad, lonely people is really an art form. Attendings are good because we haven't had hundreds of H&Ps - we've had thousands. The more experience you get, the better questions you will ask and the more efficient your "discovery phase" will be. I also think the various acronyms are nonsense, but if they help, go for it. One of the hardest things to get better at is being able to deviate from the "blanket coverage" H&P and more "focused" H&P. One of my mentors taught me to be "investigative" - in other words, you are constantly asking yourself why, more pertinent questions are provoked vs just asking the standard "how bad is your pain on a scale of 1-10?"
Part of your development will also come from your ability to tap other sources about the patient and reduce the nonsense questions you will document for billing purposes. For example: ED RN triage note "30yoM Right flank pain starting 4 hours ago radiating to the groin, been nauseated and vomiting." This could potentially alter your diagnostic thinking, unless you use it as an "optional framework." If you walk into the room, the patient is doing the kidney stone shuffle, vomiting into a bag while holding their right side - you can rip through your history pretty quick. Of course a caveat applies, unless you've seen a bunch of these (and presentations that are similar but are potentially more lethal) you may miss things - hence the "optional framework." This patient has obvious severe pain in the right flank radiating to the groin associated with N/V. Your initial question to the patient after introductions could simply be: "Mr. Jones, I understand you've had severe right sided pain that shoots into your groin with vomiting for 4 hours, have you had kidney stones before? Any fever or chills? Blood in the urine, pain with urinating?
Obviously there are more questions you would need to ask and this is a slam dunk case - but in a 30yoM stones are quickly rising to the top of your differential, you would also consider, torsion, UTI, pyelo, etc etc. The differential evolves as you are taking the history as opposed to "shotgunning" questions according to a mnemonic - unfortunately, you need to get the practice of shotgunning first, seeing a ton of patients, understanding pathology, and then your ability to power through an H&P will improve. It's all in the reps. Just practice. We all suck at them initially, doesn't make you dumb or unqualified - it makes you inexperienced, and that's one of the reasons this process takes so long. Good luck.
