The following are links to documents that I have created throughout my first rotation.

The following is a link to a History and Physical I presented during my site evaluation on a patient presenting with a severe headache, nausea, and a petechial rash on her chest:  IM_hp1

The following is a link to a journal article and summary (first page of attached document) that helped me understand the patient’s (described in the H&P above) treatment: article_summary

The following is a link to a report generated via Typhon that lists my hours, diagnoses I saw, and some of the procedures I did:  tally

The following is my site evaluation summary:

During my site visit, I was with three other students – 1 from internal medicine and 2 from ambulatory care. We started the visit by presenting our cases. The preceptor was reflective about our cases and would interject to ask about a differential based off presenting symptoms. During my presentation on a 21 year-old-female, she reminded me that I should also be educating her on safe sex practices and annual gynecologic visits. The preceptor emphasized the importance on education since as PAs we are expected to think with a primary care background. Everyone did well, and our preceptor was impressed. Afterward, we went through our pharm cards, and she asked about some of the drugs’ major side effects. The site evaluation went very well.

The following is my reflection of this rotation:

Exposure to new techniques or treatment strategies – how did that go?

Throughout this rotation, I have noticed how there is a textbook way of going about certain procedures or treatments and then there are the ways that things are done in practice. This was both logical and worrisome in situations. For example, we were taught to hold down pressure for at least 5 minutes after doing an ABG to ensure that a hematoma does not form and result in potential amputation. In practice, the respiratory therapists told me that as long as the bleeding stops after holding pressure, the pt is at a decreased risk of having a hematoma. When there are a lot of patients, it makes sense that there isn’t enough to spend holding down pressure for a minimum of 5 minutes on all of them, but it still made me apprehensive considering how much this was emphasized in class. The next few ABGs I did, I listened to the respiratory therapists since they would be watching me to make sure I did them right, but I would come back a little later to make sure the patients hand was okay. I had to learn to mix what we learned in class vs. what happens in practice.

Another difficult experience I had was inserting an NG tube in someone who was awake but nonresponsive. They were slumped in their bed with their head leaning to one side. I couldn’t tell them to swallow or bend their head forward or really gauge if they were in pain when I inserted the tube. I tried but I told the PA who was watching me that I felt too much resistance and did not want to keep pushing. She tried, but it ended with the pt having a nosebleed and we had to stop. Because my first ng tube insertion was this difficult, I’m hoping the next one will come more naturally.

Types of patients you found challenging in this rotation and what you learned about dealing with them

Pts who have been in the hospital for a long time (several weeks) are difficult to deal with because they are likely lonely and want to talk for a while when you are with them. They quickly go onto tangents that are no longer relevant. I feel bad because I know they are probably lonely and just want someone to talk to, but I also don’t have the time to sit there and just talk to them. What I’ve found is just being honest and saying, “I have to get going,” works very well. They are usually never offended when I say that and let me go. Simply getting up and walking toward the door is ineffective. I initially thought that would give them the cue that I had to leave, but it does not. You need to verbally cut them off a little and say that you have to go.

What was a memorable patient or experience that I’ll carry with me?

A pt was admitted for a large, multiloculated abscess on her thigh. The attending sat with me and another PA student and asked us if we wanted to start her on clinda or vanco. He told us that the area’s antibiogram showed that clinda covers 50% of the staph infections whereas vanco covers 100%. I was unsure, and suggested clinda initially and if it didn’t work to move to vanco as to not build resistance to vanco. He then looked at us and said, “okay, now imagine if this were your mother. Would you give the drug that works 50% of the time or 100% if it meant she could lose her leg?” I immediately said vanco. Before I started rotations, that’s how I said I would view all my patients – like they were one of my family members, but until I was put into that situation, I realized how easy it is to stifle that approach. Since then, I have genuinely been seeing patients more as family members rather than just patients and it’s definitely increased my level of empathy.

What do you want to improve on for the following rotations? What is your action plan to accomplish that?

Although it may sound trivial, I feel like I don’t sound confident enough. I want to project more, use a deeper tone of voice, and carry myself higher. One day I got into a conversation with one of the fellows about how I felt like people took what I said less seriously because I was wearing a short white coat. He responded by saying, “This morning when you presented, attendings, residents, PAs, NPs, pharmacists, dieticians were all holding onto every word you said. The attending asked you questions about the patient and trusted the responses you gave. Just because you’re wearing a white coat doesn’t mean people automatically take you less seriously. It depends on how you carry yourself.”

After he said that I began to evaluate if I was giving myself enough credit. I want to take his advice seriously and be more confident in what I know and be honest if I genuinely don’t know something. I don’t want to constantly be afraid of getting things wrong. I want to truly accept and recognize that getting things wrong occasionally in learning situations is okay and not going to make people think I’m untrustworthy.