- IM Evaluation Reflection: During my Internal Medicine rotation evaluation, I presented my 3rd H&P for evaluation and critique. While my overall approach and concision was well done, I received feedback that I didn’t fully cover all of my bases. My patient was a fairly straightforward patient who had a tri-malleolar ankle fracture and was being admitted for surgical repair. I went over main body systems as the PA I shadowed asked me to do, and went through all labs and scan and presented a plan along with differentials. While these we done well, I was told that not performing a digital rectal exam on my patient could have been catastrophic for my patient in that something as sinister as colorectal cancer could be missed. I need to be more focused on the big picture and the overall patient, rather than just the problem at hand. Going forward I want to work on being more thorough and inclusive with my H&Ps. Making sure I offer all parts of a full physical to my patient and at least documenting refusal if they do not want certain parts to be performed.
- IM Article Summary: I really enjoyed this article about 3D printing being used in the application of planning tri-malleolar surgeries. While this study took place in China and only had about 30 participants, I still valued the novelty of something as progressive as using 3D printing in surgical practice. All 30 patients received a CT scan of their fractured ankle prior to surgery, whether they had a 3D printed model of their fracture or not. 15 patients underwent surgery after surgeons practiced and studied the 3D model of their fractured ankle while 15 underwent surgery with only the CT prior. Overall, the patients who had 3D models created prior to their surgeries experienced shorter surgery times, less blood loss, and overall higher satisfaction than the patients in the group who did not. I hope that this continues to be a novel approach to surgery in the future overall.
- IM Self-Reflection: My first rotation, Internal Medicine, was a perfect place for me to start with clinicals. I learned how to perform procedures such as ABGs, NG tube placements and the interpretation of ECGs. While I learned to better perform ABGs and became quite proficient at it, NG tube placements were difficult for me throughout the whole rotation. I also experienced many patients at the end of their lives. Palliative care has a heavy presence on the main floors of the hospital and I valued learning that giving care and dignity at the end of someone’s life can be just as valuable as a lifesaving procedure. While this was sad for me to have to watch, I felt that it has helped me to better value the overall humanity of each of my patients. This experience has set me up to better evaluate patients as well. Many patients on this rotation had other comorbidities and complications besides what they were first admitted for in the first place. Going forward I feel like this will help me to have a more holistic approach to medicine and to treatment for any patients I get to care for. Overall, I felt much more like myself throughout this rotation. Having come from a background of many years of patient experience in a hospital, I felt much more at ease and in my element while seeing patients on the floor. It was almost cathartic for me as I found I really missed being in a hospital and helping patients. I think that my newly learned skills and the continued honing of the ones I have already acquired will continue to contribute to my becoming the best PA I can be.
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