HPD Self Assessment

Bailey Schaefer
Canadian Memorial Chiropractic College
CE1101
April 4th , 2023

Word count:1595
 When first arriving at CMCC and participating in the surprise history during O-week, I
remember walking in to see my patient sitting on the treatment table and with the little
experience I had prior to arriving at CMCC, I asked “what brings you in today”? My patient
explained that she had hurt her back taking a turkey out of the oven for thanksgiving and is not
sure what happened. I then began asking questions at random not really knowing the purpose
of why I was asking the question other then the fact that the question sounded important. I also
remember there being numerous accounts of awkward silence in between my questions
because I wasn’t sure which direction I wanted the encounter to go in and if I had asked enough
questions or if I should ask a few more. Looking back at the surprise history, I have obviously
learned the theoretical and practical material to conduct a proper history on a patient while
asking all of the relevant and necessary questions. Another consideration that I now have which
I did not have when first conducting the history is that the patient may have a non MSK related
issue that needs referral and it is important to conduct a physical before providing advice to the
patient. During my history I never thought that my patient may have a condition more sinister
that needs a referral, and I was also giving advice on flexion and extension back exercises
which I now know may be detrimental for someone with low back pain depending on the
diagnosis. After the history and into the following weeks I reflected on the utilization of my soft
skills and what I was able to take away from this experience. One soft skill I haven’t necessarily
learned at CMCC but have realized the importance of is being able to reassure the patient.
During my history I did not attempt to reassure my patient when they were scared and continued
to ask if they were going to be okay; instead I kept asking questions to try and find a root cause
to their pain, not paying any attention to the worry they had. As they became more and more
worried, the solution I had was to ask more questions and try to give a specific explanation as to
how to fix their back rather then calming them down and reassuring the patient that everything is
going to be taken care of.

Now as I reflect back on my HPD experience and compare it to my surprise history

experience during O-week, I noticed improvements in certain aspects of myself that I assumed I
would improve in, improvements in certain aspects of myself that I didn’t consider I would
improve in, as well as aspects of myself that I actually liked better in the surprise history more
then the HPD. I noticed that in between my history from week one and my HPD I learned the
different components when taking a patients history which included a thorough neural exam, a
brief history on the patients health, screening for red flags, and a systems review. One small
piece of material that I learned was that for a patient with possible disc herniation, you do not
always need to send them for an MRI to confirm and instead, depending on the case at hand,
as a clinician I would treat the patient as if they had a disc herniation and only request imaging if
the patient were to get worse. I also learned how to word certain questions in a manner that is
geared toward the patient. What I mean by my statement is that certain questions I asked during
O-week are questions I am still asking now, the difference is that the same questions I ask now
are far more concise and more tapered to the knowledge and level of understanding of the
patient. One area of myself that I didn’t consider improving on was my confidence in taking a
history and how that may indirectly ease the patients worries as they can see I know what I am
doing. Watching my HPD video, I liked seeing how I went from question to question without any
awkward silences, but also with a purpose in mind as this time I knew exactly which direction I
was planning on going. I also felt that I did a good job at letting the conversation flow naturally
from one question to another and although I had “PPM FLOATS” and “OLD CARTS” in my head
so I knew what questions to ask, I was able to bounce between letters when the conversation
wth the patient lead that way.

When reflecting on aspects of the HPD that I could improve on, there were two major
areas that I noticed. The first area being I didn’t spend much time treating the whole patient.
What I mean by this is I spent almost no time trying to get to know the patient and building
rapport with them. This lack of interaction may be due to the fact that I had to complete the
history in 6 minutes which forced me to only include crucial aspects to try and find a solution to
the patients root cause of pain. Regardless of the timer holding me accountable, I would have
liked to have come across a bit more personable since I believe that just listening to the patient
and taking their mind off of their reason for visit is a treatment in itself and when a clinician
claims they treat the entire patient, this includes physical, and psychosocial aspects. The
second area I could have improved on was conducting my physical tests in a more orderly
fashion. I started off with my patient standing and then sitting before I asked them to lay down;
but once laying I had them switch back and fourth between laying on their stomach and back
numerous times as different tests kept coming to mind. Based on the intake forms that the
patient filled out, I entered the room already concluding what they had, which is completely
wrong of me to do. After quickly realizing they did not have what I had already concluded, my
order of tests became scrambled since I was now conducting tests that I did not plan on
conducting.

At the moment I would say one of my major knowledge gaps is that I have not been
informed and educated on all of the possible diagnosis for low back pain, or the manifestations
in which certain low back pain disorders may present with. A second gap of knowledge I believe
I have is that I am not well enough equipped to deliver effective patient education on most back
disorders. In class there have been numerous back disorders brought to light, but when
explaining the science behind how these disorders manifest in a patient, or how they can be
treated, I feel I still need more time to learn and dive into each disorder. Luckily I have an action
plan that will fill my gaps of knowledge and prepare me for future encounters for patients with
low back pain. During lectures, labs and other class content, I have been making lists of
questions where I will approach the professor at the end of class and ask how the material we
were just taught pertains to a specific low back disorder and how I, as the clinician, would treat a
person with that condition. I also follow numerous chiropractic and healthcare podcasts that I
listen to throughout the week. By listening to these podcasts I’m hoping they fill certain
knowledge gaps that I am aware of, but also fill knowledge gaps that I didn’t know I had; and
ideally by listening to podcasts every few days I can slowly become a more well rounded
chiropractor.

This experience of reflecting on both the HPD and O-week history has opened my eyes
to what I need to work on moving forward at CMCC and what skills I would like to improve on by
the time I become a clinician. One of the biggest takeaways from watching the HPD video which
I will continue to reflect on is my non-verbal communication. Often times I reflect on the words I
said to a patient or how I said certain phrases and how they may have been interpreted by the
patient. I almost always neglect to put thought towards my non-verbal cues such as hand
placement or did I come across as closed off and this video allowed me to see what I liked
about my body language and certain mannerisms that I did not like and would not have noticed
if it were not for the HPD video. Since my mind was racing during the physical examination, I
was moving very fast and not considering how moving back and fourth across the room would
make the patient feel. This video will help shape my future as a clinician because I will now put
focus on an important yet overlooked area of patient communication, body language. Overall,
this opportunity to reflect on where I started during my history on O-week and where I am now
after my HPD has allowed me to see how far I have already come as a student, but also how
much further I need to go and what skills I should continuing working on throughout my next few
years and into my time as a clinician.