During this 5 week rotation, I learned that I really enjoy interacting with patients. I like to be able to interview them, and gain their trust. Then, as I get to know them, and the reason why they came to visit the clinic, it was great to comfort them that their worries about their illnesses were not necessary, and that we were able to help them. Granted, there will always be those handful of patients who may not be the most kind, but I was able to sympathize with their position. I realized that their disposition may be due to their own personal issues and concerns, and that I should not take them personally.
Skills or situations that are difficult for you and how you can get better at them.
At the beginning of the rotation, I had to get used to interviewing the patients and getting a good history in order to present the patients to my preceptor. I was using scrap paper to write down everything the patient was saying: their story, symptoms, and pertinent positives and negatives. Within a week of the rotation, I was challenged to go “paperless” when interviewing patients. This was the most difficult transition to do, as I took comfort in holding my paper and pen, and jotting everything down so I would not miss nor forget anything. At first my presentation was disordered, and I would miss a lot of the history that I had acquired. However, as time went on, I realized that making more eye contact, and just talking to the patients, helped in my recalling different parts of the H&P. I was also advised by my preceptor to collect a quick ROS in order. For example, to ask if theres any constitutional symptoms, then if there are any issues- going in order through each body system. Doing this helped me visualize the patients issues, and organize my thoughts in order to be more effective at presenting. I will continue these methods, and practicing taking histories to get better.
What was a memorable patient or experience that I’ll carry with me?
There was a 56yo female patient who came in complaining of waking up in the morning with dizziness and diaphoresis, and sinus congestion x 2 months. The patients vitals were all within normal limits, except for her pulse at 56bpm. After getting the patients history, and performing the physical exam, I felt confident that the patient had bacterial sinusitis, and the symptoms she had starting that morning was due to her sinuses acting up. However, when I presented to the preceptor my findings and potential diagnosis, he asked to get an EKG. My preceptor explained how a patient in their 50s, female, low pulse, with her acute symptoms needs to get checked for any cardiac issues.
The EKG came back showing T wave inversions in a few consecutive leads. We ended up sending this patient to the hospital. This case stressed to me how vital it is to create a broad list a differentials, and to rule out any potential emergencies, before officially diagnosing patients.
What one thing would you want the preceptor or other colleagues to notice about your work in this rotation?
I would like my preceptor and colleagues to notice that I had pushed myself out of my comfort zone from the very beginning. For the first patient I saw at the clinic, I had shadowed my preceptor to watch his patient interaction. However, when it was time to see the second patient, he told me to go see the patient and report back to him. I was not expecting this! My preceptor noticed this, and literally said something along the lines of, “yep! I am throwing you straight into the water.” Another example of being pushed was as described in the second question. At first I was afraid to see patients without notetaking, but I had accepted my preceptor’s challenge to just go for it. Even though I had struggled in presenting these patients at first, as the time went on, I got better at organizing my interviews, which helped with my presentations.
