From starting my rotation at NYPQ for Internal Medicine, to my Long Term Care rotation, I have spent a total of 9 weeks working with the Internal Medicine team. When I first started, I did not know what to expect. The physician assistants I worked with were extremely busy, and there were so many moving parts to their daily schedule. I felt out of place, and did not know how I can learn from, or contribute to the rotation. After spending two nearly two months with the team, I can now say that I have a much stronger grasp at the role and responsibilities of a medicine PA. I felt like I gained the trust from the team, and therefore was given the opportunity to take part in their daily tasks. I helped review the patient’s charts and notes/recommendations from other specialties, so we would know the next steps for the patients’ hospital course/treatments. I joined the PAs when they rounded on their patients in the morning so we can update them on what has been going on and planned for their care. I was able to help out with writing admission and discharge notes, as well carry out tasks that were asked of me. I was most proud that the PAs would come to me, and trusted me to do ABGs on their patients. I practiced so many of them that I can see myself perform it independently! I hope that my preceptor and the PAs I worked with noticed my strong work ethic, curiosity to learn, and my commitment to helping the team.How could the knowledge I’ve gained here be applicable in other rotations/disciplines?
Long Term Care has additional parts of the history and physical that is needed in caring for this patient population. The first major example can be seen in describing the patient’s social history. There is an emphasis placed on the patient’s living situation, specifically to identify the type of residence. Regardless of whether it was an apartment building or house, I learned that it was important to inquire on how many flights of stairs may be involved. Additionally, we need to ask if the patient is able to ambulate with or without assistive devices. These components of the history are important to understand the patients’ functional status. It can also highlight potential areas that can affect the patients’ independence, and where assistance may be needed. Describing the types of ADLs and IADLs the patient could do, and whether or not they had familial or outside help was another important component to highlight the needs of the patient. In a patient that I presented who had a fall, I learned how important it was to check the patient’s feet. It is important to check if the patient has full range of motion at the feet and ankles, since any issue there may be the reason for the fall. I found that all these important parts of the history and physical could be applicable to my patients in other specialties as well. Noting these aspects can be useful when evaluating and documenting patients with physical disabilities, or those suffering a recent health/physical issue that prevents them from carrying out their daily activities.
Types of patients you found challenging in this rotation and what you learned about dealing with them
The elderly population was always the patient group that made me the most nervous. I believe this is because of the number of diseases and conditions that arise with age. I came into the rotation with the belief that these patients are vulnerable and “closer to death”. I felt that any of the medical conditions the patients had, risked their deterioration at the hospital. For the most part, I still believe this is true, but have seen exceptions where patients over 80s, still had less medical problems than those in their 40s-60s. Interviewing the geriatric patients with cancer was another hurdle. I have had family members pass away from cancer, so this disease hit close to home. At first it was difficult hearing their stories since I often would be reminded of my experiences. Towards the middle of the rotation, I realized that these interactions were reminders of why I wanted to become a PA. I wanted to give back to the medical community with the same care and compassion my family and I experienced.
What was a memorable patient or experience that I’ll carry with me?
One memorable patient I met on this rotation was a man who was brought in for evaluation of a stroke. The day before, he had an episode of dizziness at 4pm while going grocery shopping with his daughter, who is a nurse. He had to be escorted to his car during that episode, and had his daughter drive him home. At 11pm, the patient felt generalized weakness as he went to bed but did not mention this to his family. He was awake and worried until 1:30am, when his daughter asked him why he was not asleep yet. At this moment, he and his daughter noticed he was having slurred speech and right sided weakness. When the overnight stroke team first received him, the patient was already out of the window for tPA. With no evidence of large vessel occlusion on the CT and CTA, and presenting more than 6 hours after onset of symptoms, the patient was unable to get a thrombectomy. This patient stood out to me, because I was sent to assess him the morning I came in. His voice was mildly slurred, and the only other positive finding on exam was ⅘ strength on the right arm with no limb drift. When I returned to see the patient later in the day with the stroke team, his right arm strength became ⅖ and he had limb drift. It was a devastating case because medically, there was not much else the medical team could do besides consider anticoagulants and physical/speech therapy. I also felt for the patient’s daughter. When placing myself in her shoes, I too may not have had “stroke” cross my mind with the initial symptom of just dizziness. It makes me reconsider my differential diagnoses, and threshold for suspecting medical issues in my future practice, and with my family.
