How many H&Ps do you write?

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[Taddy Mason]

I’m a 4th year med student, and I’m feeling pretty under prepared for residency. I was browsing Reddit, and a thread mentioned that one student had written ~500 H&Ps half way through clerkships. At my institution the attendings can’t bill for med student notes which means they largely ignore them, and nothing is really expected. I’ve written probably less than 100 H&Ps so far, and I feel dumb as a box of rocks constantly. Maybe these are connected? 😂

500 H&Ps....? I’m half way through my 3rd year of residency and I haven’t even come close to 500 H&Ps.

 

[ciestar]

500?! That doesnt seem real.
i didnt write many as a med student either. You’ll be fine not writing 500. Trust me.

 

[angeloflogic]

DO school, M3 at year long level 2 trauma hospital where students were worked. I'm estimating <200 M3, <100 M4. I did around 1500 notes as a scribe.

 

[Tenk]

Funny thing is once you’re actually practicing nobody reads the actual H and P except attorneys. Doctors just read plans, MDMs, and discharge summaries to save time.

Wouldn’t stress about it. Just enjoy M4 and leave it for residency.

 

[CocoMelon0531]

DO school, M3 at year long level 2 trauma hospital where students were worked. I'm estimating <200 M3, <100 M4. I did around 1500 notes as a scribe.

Full H&Ps. That doesn’t mean your progress notes which can be done in 2-3 mins each.

 

[aafisahar]

I definitely wrote less than 25 H&Ps as a student, probably less than 10. By the end of intern year, I could do most admissions in less than 45 minutes including talking/examining the patient, putting in orders, and writing the note.

Trust the process.

 

[AzBasRad]

You attend a top 25 med school and have step scores > 255. I am an MS4 whose profile is not as competitive as yours and my first patient contact would be > 1 year when I start my intern year - and I am not worried. You should be fine. Enjoy the last bit of freedom.

FAQ: What are my chances?

Just had a few questions about how many programs to apply to, etc. Medical School: Mid-tier US M.D. School Pre-clinical: All Pass Clinical: Mixture of H, HP, and P Step 1: Low 250's I was mainly wondering how many radiology programs and how many prelim/TY programs people apply to on average...

forums.studentdoctor.net

 

[7331poas]

imagine writing more than 10 HPs. yikes

 

[Matthew9Thirtyfive]

just remember old caarts and ur good to go

Is that like opqrst? Lol

 

[Keep2r]

Don’t stress about writing H&Ps. In residency nobody will read them except you anyway. A lot of new interns spend hours perfecting their notes and leave at 10PM everyday without realizing that the only use your note has is to serve as a billing tool for your attending. As long as you keep the assessment and plan clear and concise, you should be done with a note within 15 minutes max. As a medical student you shouldn’t focus too much on this menial task, instead focus on your medical knowledge. The efficiency will come independent of how much you practice as a student.

FYI I am replying to you after sitting down and writing 10 progress notes + 2 H&Ps over the past 3 hrs.

 

[ciestar]

Don’t stress about writing H&Ps. In residency nobody will read them except you anyway. A lot of new interns spend hours perfecting their notes and leave at 10PM everyday without realizing that the only use your note has is to serve as a billing tool for your attending. As long as you keep the assessment and plan clear and concise, you should be done with a note within 15 minutes max. As a medical student you shouldn’t focus too much on this menial task, instead focus on your medical knowledge. The efficiency will come independent of how much you practice as a student.

FYI I am replying to you after sitting down and writing 10 progress notes + 2 H&Ps over the past 3 hrs.

The HPI in my progress notes are hilarious tbh

 

[doyouhaveaflag]

My chief always likes to say you should spend less time on the note than you do with the patient. I haven't achieved it yet for H&Ps, but I strive for it every day.

Only somewhat related, I think the most important thing in your note should be your pager or contact info so I know how to get ahold of you. For about 75% of my consults, the primary team has no contact info in their notes and I spend ten minutes on each trying to figure out how to contact the team to give them my recs because I know no one is actually reading my note.

 

[NicMouse64]

My chief always likes to say you should spend less time on the note than you do with the patient. I haven't achieved it yet for H&Ps, but I strive for it every day.

Only somewhat related, I think the most important thing in your note should be your pager or contact info so I know how to get ahold of you. For about 75% of my consults, the primary team has no contact info in their notes and I spend ten minutes on each trying to figure out how to contact the team to give them my recs because I know no one is actually reading my note.

Think this is definitely possible with dot phrases. One thing I will say is that doing a good chart review will probably always take longer than I spend with the patient, or maybe it's just my m3 ignorance and thinking I need to know everything.

 

[TelemarketingEnigma]

number of notes has varied widely by rotation and preceptor for me (even within the same hospital, some services wanted us to write notes for funsies while others didn't bother). I probably wrote the most notes on FM, usually like 3-8 notes a day depending on preceptor. (x5 weeks = 100ish notes? probably a little less. and some of those were simple followups with shorter notes). I probably wrote up 15-20 full psych evals. On IM I think I've done maybe 4-5 H&Ps over 3 weeks so far? (but lots of soap notes.) Some rotations the only H&P I did was the mandatory one that we have to turn into our school for an assignment. I think I did 1 H&P on ob/gyn, none on peds (except the mandatory one).

500 halfway through 3rd year seems like a LOT to me. I think its helpful to practice writing them, but not to spend all your time writing notes that aren't used for anything

 

[ciestar]

My chief always likes to say you should spend less time on the note than you do with the patient. I haven't achieved it yet for H&Ps, but I strive for it every day.

Only somewhat related, I think the most important thing in your note should be your pager or contact info so I know how to get ahold of you. For about 75% of my consults, the primary team has no contact info in their notes and I spend ten minutes on each trying to figure out how to contact the team to give them my recs because I know no one is actually reading my note.

I love Epic Haiku for this reason. Can get in touch with anyone easily.

My plan takes me the longest... but it takes longer with more complex medicine admits

 

[Eye-eye]

Think this is definitely possible with dot phrases. One thing I will say is that doing a good chart review will probably always take longer than I spend with the patient, or maybe it's just my m3 ignorance and thinking I need to know everything.

Well, the problem when you're just starting out is that you don't know what's important / what you'll get asked (or pimped) about. So if you want to know the answer to the chief or attending's questions, you have to know EVERYTHING.

As to OP's comment, though, I have a feeling the person who said they wrote 500 H&Ps meant notes, not a true, full H&P. I probably did about 500 notes in M3, but I'd guess at most 10 full H&Ps. In M4, on the other hand, I've probably written about 5 notes in total... I've gotten pretty lucky so far. Then again, I still have one clerkship to go.

 

[Taddy Mason]

Well, the problem when you're just starting out is that you don't know what's important / what you'll get asked (or pimped) about. So if you want to know the answer to the chief or attending's questions, you have to know EVERYTHING.

As to OP's comment, though, I have a feeling the person who said they wrote 500 H&Ps meant notes, not a true, full H&P. I probably did about 500 notes in M3, but I'd guess at most 10 full H&Ps. In M4, on the other hand, I've probably written about 5 notes in total... I've gotten pretty lucky so far. Then again, I still have one clerkship to go.

Even 500 progress notes seems like a pretty big stretch.

 

[NicMouse64]

Even 500 progress notes seems like a pretty big stretch.

I wrote about 5/day on my IM rotation (am and pm rounding). Used to be 12 weeks, now is only 6 weeks. 30 (days)*5=150. On surgery wrote about the same. I think progress notes is more reasonable.

 

[Taddy Mason]

I wrote about 5/day on my IM rotation (am and pm rounding). Used to be 12 weeks, now is only 6 weeks. 30 (days)*5=150. On surgery wrote about the same. I think progress notes is more reasonable.

It’s still less than 500 and I highly doubt most med students are writing 5+ progress notes 5 days a week for every rotation.

 

[NicMouse64]

It’s still less than 500 and I highly doubt most med students are writing 5+ progress notes 5 days a week for every rotation.

have only had IM,FM, Surgery so far. We had 2-3 patients for rounds. Not sure what happens at other schools though. the 500 H+P thing definitely doesn't seem possible to me.

 

[Eye-eye]

I did 2-3 (usually 3) before rounds and sometimes a couple in the afternoons on clerkships (or the occasional admit H&P). That x30 weeks of clerkships and about half that x12 weeks of electives (if I'm remembering my weeks right) = over 700. I may be slightly overestimating, and those afternoon notes and some of my surgical elective notes were pretty short, but 500 isn't that much for regular old notes depending on the culture surrounding notation at one's institution.

 

[longhaul3]

Only somewhat related, I think the most important thing in your note should be your pager or contact info so I know how to get ahold of you. For about 75% of my consults, the primary team has no contact info in their notes and I spend ten minutes on each trying to figure out how to contact the team to give them my recs because I know no one is actually reading my note.

I have stopped doing this now that notes are immediately accessible to patients. It's unacceptable for patients to have access to my service pager. Every now and then I get a page from a patient's family member who happens to be a nurse or physician at the hospital and knows how to page me. It makes me livid.

It's the primary team's responsibility to read your consult note. Those are your official recommendations. I don't expect a call back for a routine consult and rarely act on phone recs unless it's an urgent situation. I just want it in writing.

 

[dienekes88]

I'd be shocked if I wrote more than 100-150 h&p/initial consult notes during 3rd year.

Just focus on getting straight to the point. I hate the autopopulated notes, so I try to dictate them. At first it takes a lot of focus and work to generate a short well written consult, but this is about quality reps not quantity reps.

 

[ciestar]

I did 2-3 (usually 3) before rounds and sometimes a couple in the afternoons on clerkships (or the occasional admit H&P). That x30 weeks of clerkships and about half that x12 weeks of electives (if I'm remembering my weeks right) = over 700. I may be slightly overestimating, and those afternoon notes and some of my surgical elective notes were pretty short, but 500 isn't that much for regular old notes depending on the culture surrounding notation at one's institution.

Progress notes and H&Ps are different. But OP might have been calling them the same thing which makes so much more sense.

 

[Dr G Oogle]

H&Ps writing skills are not that hard to get. As an intern you’re basically drinking out of a fire hose you’ll figure within 2-3 months how to write proper ones even if you have written a dozen in med school. It doesn’t have to be prose a la “it was a dark and stormy night and the 45 yo WF felt turmoil epigastrum, as if two albino squirrels were fighting over a chestnut. She reached for an antacid sitting on her antique cedar bookcase thinking it would help, but alas it did not, hematemesis was hiding in the shadows...”

just focus on differentials learning about presentations of disease and ask lots of questions.

 

[Matthew9Thirtyfive]

H&Ps writing skills are not that hard to get. As an intern you’re basically drinking out of a fire hose you’ll figure within 2-3 months how to write proper ones even if you have written a dozen in med school. It doesn’t have to be prose a la “it was a dark and stormy night and the 45 yo WF felt turmoil epigastrum, as if two albino squirrels were fighting over a chestnut. She reached for an antacid sitting on her antique cedar bookcase thinking it would help, but alas it did not, hematemesis was hiding in the shadows...”

just focus on differentials learning about presentations of disease and ask lots of questions.

This is totally going in my first note as an attending.

 

[Lem0nz]

H&Ps writing skills are not that hard to get. As an intern you’re basically drinking out of a fire hose you’ll figure within 2-3 months how to write proper ones even if you have written a dozen in med school. It doesn’t have to be prose a la “it was a dark and stormy night and the 45 yo WF felt turmoil epigastrum, as if two albino squirrels were fighting over a chestnut. She reached for an antacid sitting on her antique cedar bookcase thinking it would help, but alas it did not, hematemesis was hiding in the shadows...”

just focus on differentials learning about presentations of disease and ask lots of questions.

More importantly than this, be very cognizant to not end your note with "though the patient has had some very pointed questions, the patient is a kind and caring individual of the utmost personal character, a caliber that we should all aspire to, and deserves the absolute best that ______ medical system has to offer. Please greet him with a smile and a kind gesture each and every time you enter the room to reinforce that we have his best interests at heart and only want to provide him world class care."

That one got me in deep ****. But the nurses freaking loved it, they printed it out and hung it on the walls. Patient was such an ass.

 

[Lost in Translation]

More importantly than this, be very cognizant to not end your note with "though the patient has had some very pointed questions, the patient is a kind and caring individual of the utmost personal character, a caliber that we should all aspire to, and deserves the absolute best that ______ medical system has to offer. Please greet him with a smile and a kind gesture each and every time you enter the room to reinforce that we have his best interests at heart and only want to provide him world class care."

That one got me in deep ****. But the nurses freaking loved it, they printed it out and hung it on the walls. Patient was such an ass.

I’ve definitely been passive aggressive in notes before but hasn’t come to bite me (yet).

 

[Matthew9Thirtyfive]

The most initial h&ps I’ve written in a day so far has been 5. Usually is between 3-5 plus any progress notes. On my OR days, it’s just the progress note(s). At that pace, definitely not hitting 500.

 

[Redpancreas]

I’m a 4th year med student, and I’m feeling pretty under prepared for residency. I was browsing Reddit, and a thread mentioned that one student had written ~500 H&Ps half way through clerkships. At my institution the attendings can’t bill for med student notes which means they largely ignore them, and nothing is really expected. I’ve written probably less than 100 H&Ps so far, and I feel dumb as a box of rocks constantly. Maybe these are connected? 😂

An H&P is an admission note with several elements and quality of an H&P highly depends on the writer. I have worked at a residency with top/mid tier US MDs and they still drastically mess up H&Ps to the point where a midyear intern/senior has to write a separate "addendum" complete H&P. Unfortunately, the quality of clerkship experience has drastically deteriorated across the board in my experience. Contributing factors have been increased requirements of notes, increasing complexity of patients, as well as increased liability essentially forcing residents/attendings to take over the meaningful elements. Add this to the fact that medical schools are not held accountable for residency preparedness of their students and you've got a perfect storm.

Also, there is a matter of what this M3 is calling an H&P. In some instances, I have seen this pass for an H&P for a primary service:
84F admitted for hip fracture. Medical history consists of diabetes and high blood pressure. Denies recent aspirin use.

Plan:
-PT/PTT/CHEM-7
-NPO at midnight
-OR Monday for ORIF
-Medicine for comanagement (with the implied understanding being medicine writes a detailed consult note).

Tl;Dr: Attendings hardly mind what M3s do/write so no matter what they say they're doing and how much, it's unlikely to come under the scrutiny it would if the student were a resident so pay no mind to what an M3 claims to be doing. I'm not saying there's students/schools who far exceed these expectations and maybe SDN has a few of them, but now experiencing training at three different schools at various tiers in either a student/resident capacity, this has been what I have observed. COVID hasn't helped the situation either as it led to further underutilization of medical students.

 

[Redpancreas]

Well, the problem when you're just starting out is that you don't know what's important / what you'll get asked (or pimped) about. So if you want to know the answer to the chief or attending's questions, you have to know EVERYTHING.

As to OP's comment, though, I have a feeling the person who said they wrote 500 H&Ps meant notes, not a true, full H&P. I probably did about 500 notes in M3, but I'd guess at most 10 full H&Ps. In M4, on the other hand, I've probably written about 5 notes in total... I've gotten pretty lucky so far. Then again, I still have one clerkship to go.

This is an honest assessment. Some M3s may not have even done 10 full H&Ps in medicine. I remember being delegated to med-rec duties as an M3 (i.e. tracking down the family, calling the SNF). When I was done, the H&P was already done but I was told to write a practice H&P at home and compare it against his but no need to see the patient because he/she has already seen them...hardly exciting.

 

[SurfingDoctor]

How many? Too many. Thanks for asking.