Exposure to new techniques or treatment strategies – how did that go?
During this rotation, I was able to perform many blood draws, finger sticks, EKGs, urinalyses, urea breath tests, and physicals, including annual, pre-employment, and CDL physicals. As the weeks went on, I became increasingly comfortable and competent in completing all of these skills. I also learned how to complete patient charts beyond inputing the HPI, medications, medical conditions, past surgical history, past hospitalizations, family history, social history, vitals, ROS, and physical exam, which was as much as I had done during my rotation in ambulatory medicine. This involved inputing the correct assessment/ICD codes and linking each lab [matched with which lab would be covered the patient’s insurance], procedure, medication [including the correct pharmacy], imaging, or referral to the respective code followed by typing clinical notes for each treatment and associated preventive medicine counseling included. Getting used to completing these aspects of patient charts took some time but learning to master them made visits much more efficient.
Types of patients you found challenging in this rotation and what you learned about dealing with them.
During this rotation, I found that elderly patients with numerous co-morbidities and patients who have a history of CVA were challenging to manage. Being in a busy office, I would often see patients from start to finish. As such, I would triage patients, take vitals, and verify all of the information on patient charts. Patients with numerous co-morbidities had very long medication lists, which were important to reconcile. However, they would often grow frustrated with having to answer so many questions and would say, “you should have it all there already on my chart.” Needing to explain the importance of making sure we had the most updated medications and past medical history required a great amount of patience with patients who were not very willing to answer questions. Additionally, patients with a history of CVA brought in by family members who were not very knowledgeable about their family member’s conditions was also challenging. The effect that stroke can have on speech also made it quite difficult to understand patients at times and again required time and patience in making sure nothing was lost in translation. Ultimately, I found that managing older patients in general was a challenge in family medicine versus my previous more specialized rotations because it involves more comprehensive care. For example, I needed to make sure patients knew the importance of following up with the appropriate specialists for their specific conditions. I also needed to inquire about timely screenings, such as mammograms and and colonoscopies, and for women more specifically, the need to see their OBGYN providers. Moreover, I needed to provide counseling regarding smoking cessation, dietary changes, and increases in physical activity.
Managing new types of patients and the challenges that arise from that.
One population of patients that I have not frequently encountered on previous rotations but was much more exposed to during this rotation was patients with psychiatric conditions, such as schizophrenia, schizoaffective disorder, and bipolar I and II disorder. A lot of the time, these patients came together from the same program for routine check ups with one care taker. The care taker would have to come to each room and verify the medications for each patient, as the patients themselves could not give a reliable medications list or confirm or deny medications or medical conditions listed on the chart. There was also one encounter I had with one of these patients who solely wanted to converse about his sexual fantasies and encounters. This was challenging, as it was a one-on-one encounter, and I had never experienced a similar situation like it in the past. However, I managed to stay the course with taking the history and completing the physical without any mishaps. I came away from this experience feeling like it was a good introduction to what I may experience on my last rotation in psychiatry.
How could the knowledge I’ve gained here be applicable in other rotations/disciplines?
I have found that the knowledge I’ve gained during this rotation can be applicable in other disciplines, including ambulatory medicine, long term care, and internal medicine. For instance, I encountered many patients who presented for DOT/CDL physicals, which I often saw on the schedule at the urgent care clinic I rotated through during my last rotation in ambulatory medicine. However, I had not completed these physicals then as I had numerous times during this rotation in family medicine. Additionally, many of the patients who presented to the office were 65 years and older, much like the patients I saw during my first rotation in long term care. Many also have numerous co-morbidities and medications, requiring more time to better deliver more informed and comprehensive care. They also presented with care takers or loved ones during their visits, which was common in the geriatric clinic I had rotated through. Because internal medicine involves the primary care of adults, I imagine that the knowledge and experience I have gained during my time in family medicine will be similarly applicable, and I am therefore glad to have had prior exposure to the management of adult patients.
What one thing would you want the preceptor or other colleagues to notice about your work in this rotation?
One thing I would want the preceptor or other colleagues to notice about my work during this rotation was that I worked hard, picked things up quickly, and was willing to do as much as I could, from seeing patients from beginning to end, including triaging/taking vitals, drawing blood, completing EKGs, and performing various physicals [annual, pre-employment, and CDL], to becoming accustomed to all aspects needed to complete patient charts. I also did not shy away from seeing more complex patients and those with stronger personalities, which required a patience and understanding I have maintained throughout my whole time during this rotation.
What did you learn about yourself during this 4-week rotation?
During this rotation, I have learned that over the course of my completed rotations, I have learned a lot and doubt myself much less than I used to. I felt more comfortable in primarily managing patients on my own and was nearly always able to arrive at the same assessment as the doctor I was working with in the office. Compared to when I first started clinical rotations, I have much more confidence in caring for patients and feeling like I am well-prepared to practice in a few months.
