The following are links to documents that I have created throughout my ninth and final rotation.

The following is a link to a History and Physical I presented during my site evaluation on a patient presenting with epistaxis and headache: FM_hp1

The following is a link to a journal article and summary (first page of attached document) that describes the available literature regarding hypertension and epistaxis : fm_epistaxis_ha

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:

I submitted two history and physicals for my site evaluation. The first consisted of a 44 yo F with PMH of HTN p/w with HA and epistaxis. The second consisted of a man with history of a rash on his inner thighs that had been present for months with little alleviation of symptoms with various treatments. I selected an article that evaluated the literature regarding the correlation between HTN and epistaxis.

The following is my reflection of this rotation:

Skills or situations that are difficult for you (e.g. presentations, focused H&Ps, performing specific types of procedures or specialized interview/pt. education situations) and how you can get better at them

Many of my patients had been long-time smokers. For the first time, I had to do smoking cessation counseling. This was much more difficult than I anticipated because many of the times the patients were much older with a history of quitting and relapsing. They would often also comment on my age and say things like, “I’ve been smoking longer than you’ve probably been alive.” This made counseling more difficult because just because of my age, I was immediately confronted with skepticism. I had to work harder to first earn a patient’s trust.

I noticed that relatability is a huge component in gaining trust. I would often acknowledge that I might be younger than how long a patient’s been smoking; however, addiction and forming bad habits is a universal behavior that I can understand. I would explain how I would counsel my family in the same way because every life and the opportunities within it are extremely important and can only be optimized when individuals maintain good health. This introduction often helped patients’ remove some walls.

Managing new types of patients and the challenges that arise from that.

For the first time, I interacted with patients using Suboxone. These patients often greeted me with a lot of skepticism, and like with the smoking cessation, I had to work harder to earn their trust. I learned that language and the choice of words is extremely important when talking to these patients. During my first few interactions, I would ask them if they had cravings between doses (because that’s how the template I was using hard phrased the question). People would immediately get offensive and say they are not an addict and are using Suboxone because they had previously been on painkillers. For future interactions, I would ask if they felt like their pain was well-controlled with their current dose of suboxone. This resulted in a less hostile interaction.

How could the knowledge I’ve gained here be applicable in other rotations/disciplines?

Family Medicine requires increased attention to detail, more than any other rotation. There are several questions that must be asked to ensure the practice of proper preventative medicine, and the results of all the mammograms, DEXAs, colonoscopies, low-dose CTs, pap smears, etc. must be very attentively evaluated.

When I practice, I hope to bring similar attention to detail in all of my patient interactions. I never want to simply gloss over a CXR or CT. I will strive to ensure that I properly evaluate the results of all patients documents.

What did you learn about yourself during this 5-week rotation?

I learned that I enjoy a faster-pace environment. Although there were several patients I had to see in one day, I often felt like the patient interactions themselves went very slowly because so many components (especially during annuals in the elderly) had to be covered. I prefer the faster-paced Emergency Department setting where the most relevant information is obtained, proper imaging lab work and imaging are ordered, a diagnosis is made, and a treatment plan is formed all in one shot. Although continuity of care is incredible, and it was great to see patients I had seen in my first week and then again, during my last week, I have learned that I prefer the patient interactions I had in the ED more.