The best way to speed up HPIs is to better understand disease processes and workups, and this just comes with time.
Example: chest pain patient in ED. All you really need to know is when, how, character, timing, intensity, radiation, associated sx. Then a few questions like "does this feel like a prior heart attack?" A skilled resident will be able to take a chest pain hx in about a minute.
Speeding up PEs is easier, just focus. Think about why you are doing the exam. If you are listening to the lungs in a pt with lower abdominal pain then do it extremely fast, do 2 fields only. Why? Because so what if you hear a tiny bit of crackles at the base? If a patient has a neurologic complaint here is your cardiac exam: do they have a murmur, are they in a fib. Not "the S2 splits physiologically or P2>A2 at the LUSB." Are they complaining about a headache? Abdominal exam is very rapid assessing for gross tenderness and I would argue you don't even have to lay them down.
I realize the OPs question is "how do i make myself faster?" and that is what this response is answering. I am specifically rejecting the question "how do I make myself faster?" and want to emphasize the importance of taking it slow. I am answering a question not asked, but insisting that it is the question that needs asking. The long-term performance of the physician who heeds this advice will improve, even if the short-term "wow factor" is lost.
Go watch some ER docs to physical exams.
I presume from the demeanor of your post, and from the exemplifying ER docs, that you are an ER resident?
If the OP were to take your suggestion, this would be an example of someone emulating what someone else has done without having a sequential approach or clinical reasoning. The shortcutting that is significantly problematic for novices is being encouraged here. Great for an ER where the decision is NOT what is the diagnosis, but rather "critical, admit, discharge," and why some of even the most sophisticated ER docs are looked down upon by the rest of the services in the hospital. This shortcutting is also why even more advanced physicians may miss key elements of a diagnosis ("he has rhabdo, give him fluids until he doesn't, then send him home" vs " this person has rhabdo BECAUSE he has myositis because he has dermatomyositis because of the lung cancer he's got, good thing I did a MSK and pulm exam"). It
is appropriate for
seasoned clinicans making broad decisions like in an ER. It is completely
inappropriate for a medical student and novice clinician.
This should
never be the strategy of a medical student learning to integrate a physical exam or history. The concept holds true (focus questions and physical exams on things that if positive or negative will alter the diagnosis), but the manner in which is suggested is just inappropriate for a novice. With experience, a seasoned physician (even a resident) can incorporate multiple data points rapidly, even without explicitly thinking about them or looking for them. The concept of "Really Sick, Sick, Not So Sick, Fine" is a skill that is cultivated throughout intern year in any specialty, and is the one major advantage a second year resident has over 1st year intern. As the OP is a medical student, I would highly suggest
rejecting such advice as this for fear that the shortcuts will come too soon, that what a seasoned ER doctor elects to do without saying why it is elected will be burned into the mind of a novice as "the only thing to do for that complaint" resulting in hundreds of misdiagnoses down the road.
A good, concise, yet adequately thorough history and physical should take between
15 minutes and 30 minutes (best and fast) in a patient to be admitted to the hospital. This includes "looking up labs before you go in," "checking the ER note for clues," and "looking up past H+Ps." The usual H+P takes about an
hour for novices, not the one minute suggested in this response.
