- AM Evaluation Reflection: During my Ambulatory Medicine rotation evaluation, I presented my 2nd H&P for evaluation and critique. While I think my H&P was well done, my presentation may have been lacking in concision and detail. My patient was a young man who had stepped on a nail. He had a self-reported history of anxiety and epilepsy, but did not take medications for it and did not want to discuss either part of his history with us at the time he was seen. I went over all main body systems with the patient, as I was instructed to do and gave the patient a tetanus vaccine as he could not remember when he last had one. There were no labs or imaging done for him and he was instructed to rest his foot and to watch for any signs of infection (which we explained in detail). I think this particular patient was handled well given all the factors at play, the patient himself refused to discuss his neuro/ psychological history but was willing to discuss making healthy life choices and was open to advice since we explained his BMI of 40+ was an issue that he needed to keep an eye on. I feel that this could have been a more in-depth H&P had he been willing to discuss his history of anxiety and epilepsy. Going forward I will use this as an example why it is important to always ask for a full history, even on patients who present for straight forward care.
- AM Article Summary: I chose an article about Vitamin C in the prevention and treatment of tetanus. This particular article wasn’t well-founded or well-constructed, I just enjoyed the novelty of something as commonplace as vitamin C being used in the treatment of a life-threatening disease. Of the 117 patients involved in the trial, 100% of the children 1-12 years old (n=62) were associated with a 100% reduction in fatality, while in the age group of 13-30 (n=55) only had a 45% reduction in fatality. I found that because tetanus is already prevented in most countries with a vaccine, so new and relevant studies were few and far between. Perhaps in the future, there will be more research to support the claims of this one study, but until then I still found this one in particular very interesting
- AM Self-Reflection: My second rotation, Ambulatory Medicine, was an excellent rotation for me. I learned so much and was able to really work on my physical exam skills. Having worked for many years in a hospital, I’d never seen a diagnosis made by physical exam alone with no imaging or testing done otherwise. It was similar to the experience I had in Peru this past summer, where I was able to see and treat patients only by what I deduced through physical exam. I experienced mostly young and healthy patients who came in for mostly cold-like symptoms, with the occasional more complex patient. I learned that many patients used the urgent care center as a primary care-type office as they did not have a primary care provider. During these types of encounters, the PA I shadowed would explain why it’s important to have a PCP, especially for young female patients who didn’t have a Gyn specialist they saw regularly. I found this experience helped me to appropriately and empathetically treat those in lower socio-economic standings, proper patient education was a really huge part of every patient plan. Going forward, I think this will help me to always make sure my patients fully understand their various diagnoses as well as how to best live and keep themselves as healthy as possible. I also feel like my physical exam skills have improved tremendously overall after this particular rotation, I hope to continue to use them to help my patients in the future.
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