History Taking

I'm practicing thinking through a complete history and thought I'd make a post of it, so the following list will be of little interest to non-medical types, and rather mundane but very important to fellow aspiring doctors. Technically, this isn't a complete history, but it's about as complete as most practicing physicians will get. I've been told several times I am too slow and too thorough in my History and Physicals, so I'm trying to work on being faster and more concise. In school, we are taught to be as in-depth as possible, but on rotations, the attendings have been practicing long enough to know what to leave out and what to ask. The problem for students is each attending has their own set of questions they have found to be important, so as a student walking into a new rotation, you have the original, complete list of questions floating in the back of your mind, plus a hodge-podge of truncated lists from each attending you've had. I've never felt entirely comfortable interviewing patients during the H&P, and I tend to be a perfectionist about anything remotely related to a checklist, so I am quite slow and thorough, and my attending now is having me see all his clinic patients before he does, including the new patients, who need a "complete" H&P. And he is not easing up much in regard to making me practice patient interviews and has told me repeatedly that I need to speed up and be more concise. This is stressful for me since I respond poorly to any sort of negative feedback and since I'm being pressured to do something I'm poor at and also dislike. I keep coming back to the fact that I need to get better at interviewing and write-ups and realizing that this will be a good experience for me. I'm already getting slightly thicker skin and not emotionally shrivelling up when my attending tells me a new thing I've done wrong or need to improve. As for getting better at clinical skills, that's why I've typed out the History template below, so I can have it fresh in my mind again, in roughly the format my current attending prefers.

Chief complaint
History of present illness
 Onset
 Provoking/palliating factors
 Quality
 Radiation
 Severity
 Timing
 Related symptoms
 Any attempted treatment and result
 Past similar history
Allergies
Medications
Medical conditions
Surgeries
ROS
 Gen: Wt change, heat/cold intolerance, fever/chills, energy level change
 Resp: coughing, hemoptysis, dyspnea, (asthma, COPD, emphysema if not addressed above)
 CV: palpitations, skipped beats, murmurs, MI, HTN
 GI: N/V, diarrhea, constipation, hematemesis, dyspepsia, hematochezia, melena, BRBPR, clay-colored stool
 GU: dysuria, nocturia, poly/oligouria, urgency, hematuria, tea-colored urine, dribbling, sexual dysfunction
 MS: joint/muscle pain, swelling, weakness
 Neuro: numbness, tingling, tremors, stroke, seizures
Habits
 Tobacco: pack-year hx, quit date
 EtOH
 Drugs
Fam Hx
 M
 F

I'm having fun in the OR (OT if you're in a British-influenced area), and learning a lot about the logistics of surgery. I love that I am finally getting my gloves bloody digging around inside of people. That is, of course, a glorified version of what I do; I'm the designated retractor holder, the med student specialty, but my involvement grows slightly each time I assist. The main hospital at which we have worked thus far has had ongoing issues with the agreement with my school as to the level of allowable student involvement, and this issue just had another flare-up, so I've been demoted to observer (not even scrubbed in) when my attending performs surgery at that hospital, but I'm hopeful the issues will get ironed out before too long.

Scott