Exposure to new techniques or treatment strategies – how did that go?
During this rotation, I was fortunately able to complete more procedures, which was a goal for me going into this rotation. Being at an urgent care, I administered numerous vaccines, IM injections, PPD placements, arm slings, suture placements and removals, performed blood draws, fingersticks, fluorescein stain testing, ear irrigations, and of course, rapid COVID and PCR tests. This allowed me to become increasingly comfortable with the common procedures performed in ER and ambulatory settings, and I really appreciated the opportunities the providers gave me in completing them.
During one particular visit with a pediatric patient, I learned that asking the patient to jump up and down and noting pain with that movement can indicate appendicitis. This was new to me, as I have really only seen the typical RLQ pain/McBurney’s point tenderness followed by the usual tests [Rovsings, Psoas, and Obturator] performed.
Additionally, for the majority of my time in urgent care, as in the ED, I initially saw patients alone to complete the history and physical exam, then presented to the provider I was working with that day. However, I discussed the likely diagnosis and management for each patient much more as if it were my own patient in real life before going back into the room with the provider to speak to the patient regarding further steps. The provider would literally say, “Ok, this is your patient. What do you want to do?” By putting me on the spot, this forced me to think on my feet and provide my logic behind my assessment and plan, which, while it may have been intimidating at first, was extremely beneficial being as though it is essentially what I will be doing on my own in a few months. Getting into the practice and habit now was something I really learned to appreciate. Moreover, I was correct in my thinking more often than not, which was also reassuring moving forward.
Managing new types of patients and the challenges that arise from that.
During this rotation, I became more accustomed to seeing patients who do not have insurance and are self-pay. This literally involved doing the math to see how much completing certain labs add up to be and whether or not doing them would be feasible for the patient financially, or whether to just discard their blood after having already drawn it. I also saw how even needing to pay for a vaccine became a cost issue, as the Td vaccine [$65.00] is $15 dollars less than the TDaP vaccine [$80.00]. Calculating such costs to patients served as a reminder to me how patient care can really be influenced and limited by factors, such as socioeconomic or immigrant status.
How your perspective may have changed as a result of this rotation (e.g. elderly patients, kids, IV drug users, etc).
As a result of this rotation, my perspective has broadened with respect to patients living with HIV, as I had seen many present at the clinic. Many MSM patients presented as being on PrEP or PEP with some patients hesitant to discuss having HIV or the reason they are concerned about HIV in terms of sexual practices due to the stigma and other negative connotations surrounding the condition. I learned that speaking to these patients in a way that made them feel safe really helped them lower their guard and allowed for a better understanding of their concerns. Additionally, I found that many patients are actually willing to report that they suffer from anxiety and depression and are on medication to help with their symptoms. From this, I learned that despite the stigma that similarly surrounds mental illness, patients do have the courage to seek help and receive the care they need to live healthy, productive lives.
What was a memorable patient or experience that I’ll carry with me?
One memorable experience I have gained from this rotation is one during which a patient told me I should become a doctor. This patient had a medical history significant for many conditions, including cancer, so he mentioned how he sees many doctors all the time and really believed I should be one based off our interaction. Due to my experience in other rotations, it has become more natural for me to ask about patients’ overall management, so with him, I asked about the last time he followed up with his oncologist, any recent imaging or labs and if there were any significant findings, as well as how often he follows up with other specialists and his PCP for his other conditions. He noted how thorough I was and that I had excellent bedside manner, which was nice to hear from a patient as a student. This experience was particularly memorable to me because it reminded me of interviewing and counseling and how much of a difference patient-centered care can make.
How could the knowledge I’ve gained here be applicable in other rotations/disciplines?
The knowledge I have gained during this rotation could be applicable in other disciplines, such as the ER, because patients often present with similar complaints in urgent care as they do in the ER. Additionally, the patient population is similarly diverse in that patients of all ages in need of acute care present in both settings. In both the ER and urgent care, I have seen many GI complaints, including abdominal pain, vomiting, diarrhea, blood in stool, and appendicitis. I have also seen many HEENT complaints in both settings, including corneal abrasion, otitis media, acute pharyngitis, and tonsillitis. Many patients with GU complaints, such UTI, yeast infections, and STDs, also present in the ER and urgent care. I also believe the knowledge I’ve gained in ambulatory medicine will be applicable in my family medicine rotation because it will be another outpatient setting where management of patients will be similar, including with regard to being limited in terms of resources. Being able to see similar cases and presentations has helped to reinforce the management of the different diagnoses I have encountered and will likely encounter in the future both in my remaining rotations and later on in my actual practice. In addition, having exposure to atypical presentations will also help me to keep certain differentials broad so that I do not rule out diagnoses that do not present with classic symptoms.
What do you want to improve on for the following rotations? What is your action plan to accomplish that?
Despite completing a good number of procedures during this rotation, I want to improve on my venipuncture skills, especially with patients who are not as easy of a stick. Since I will be in another outpatient setting for my next rotation in family medicine, my plan is to gain more practice and experience with blood draws so that I become more competent through repetition. Additionally, since I will be back in the hospital for internal medicine, I will strive to keep doing as many as I can to further improve my proficiency, knowing that there are phlebotomists on the floor.
