My prior rotations before this one was very problem/specialty-focused. From working in an urgent care, to psychiatry, to OBGYN, I was used to focusing on specific aspects of a patient’s complaint. Starting in my Family Medicine rotation at Amazing Medical Services was a shocking experience. I was initially faced with needing to learn how to navigate the EMR, and getting used to triaging the patients. I was unfamiliar identifying and addressing patients’ every medical issue, all in one visit. With time constraints from other patients waiting, I felt very pressured to speed up the encounters. It was hard to be through, ask everything needed to be asked, educate on whatever needed teachings, and document all that was done. 

There was always this goal of mine to never become one of those providers who spent most of their time looking at the computer, and not making eye contact with the patients. However, with the detailed EMRs these days, this goal was hard to achieve. I tried my best to have seconds straight of just talking to the patients to establish rapport, and also take moments to look up from the computer when documenting. As a student, I already felt that there were so many responsibilities on my end for documentation, from beginning to end. Oftentimes, the patient charts were not complete by the end of the patient encounter, so I would need to go back and edit them during my downtime. I could not even imagine the stress as the actual provider, since I knew that my preceptor would need to put in additional time to review my notes, and fill in the rest.

I had challenges with managing patients with multiple comorbidities or issues. For example, if a patient with hypertension, diabetes, anemia, and ankle pain came into the clinic, the HPI was to reflect each complaint with the accompanying details. Especially in hypertension and diabetes, there are so many things to consider in health management of the patients (ie: medication adherence, signs and symptoms, BP/glucose readings at home, etc.). It was hard to guide the interviews to obtain the necessary information, especially when the patients went off on tangents, or when the patients are unreliable historians. To deal with this, I had to be more direct with my questions, and gently redirect conversations.

This specialty also had a vast amount of topics that needed to be addressed. From educating on medication adherence, to managing blood pressure or blood sugar, reviewing labs and comparing them to previous labs, to proper dieting and exercise counseling; this was all new to me. It was hard to properly perform all of these tasks in the allotted time, but I knew it was necessary to have documentation in case of any possibility of outside parties reviewing them. I would wonder, would they understand the challenges associated, or would they simply wonder why a box was left unchecked on the EMR.

Prior to PA school, I worked as a Medical Assistant in an Internal Medicine clinic. From my experience at this rotation, I have a newfound respect for the specialty. To be able to see the internal workings and sample being a primary provider, I see that there is an endless amount of responsibility. We hold to power, as the first line, to maintain our patient’s health, educate them, and lead them in the right direction.