FM Evaluation Reflection: During my Family Medicine rotation evaluation, I presented an H&P discussing a patient who had an ectopic pregnancy removed laparoscopically. I felt that this time I was able to adequately describe the patient’s overall presentation as well as a proper physical exam pertinent to the patient’s specific presentations. Also, my patient was well-appearing and did not have any complaints post salpingectomy and ectopic removal, she had presented for a doctor’s note to continue to stay out of work for more time as she felt she had a very physically demanding job and couldn’t safely handle it yet. I inquired as to why the patient decided to come to her primary care doctor’s office as she should have seen her OBGYN surgeon post-surgery. She explained that the situation with COVID made it difficult for her to get an appointment with her doctor and needed to make sure she would be able to stay home to adequately recover longer. I did my best to elicit a full and satisfactory history from the patient as I feel I need to work on really extracting the full story from the patients that I see. Overall, I feel as though I’m really working towards improvement on the concision of my H&Ps and hope to continue to improve throughout the rest of my clinical year.
FM Article Summary: This article discusses the subject of ectopic pregnancy after in vitro fertilization, a case report and systematic review. It is stated that while ectopic pregnancy is the leading cause of maternal morbidity/mortality in the first trimester of pregnancy, the incidence of ectopic pregnancy increases with IVF. It occurs in approximately 1.5 to 2.1% of all IVF patients. This case is presented in the discussion of a 30-year-old female patient with an abdominal ectopic pregnancy status post IVF treatment. Upon a systematic review of literature identifying and discussing abdominal ectopic pregnancy after IVF, 28 cases were considered. A variety of infertility factors came into play including a history of ectopic pregnancy and history of tubal surgery. Also, the transfer of more than one embryo was reported in the majority of cases. Several trends were discovered upon review. The leading trends include tubal factor infertility, history of tubal ectopic pregnancy in the past and tubal surgery, higher number of embryos transferred, and fresh embryo transfers. While more high-quality research needs to be done in order to fully quantify and label the likelihood of ectopic pregnancy development status post IVF treatment, these trends seen on systematic review seem to coincide with known and established causes of ectopic pregnancy, such as tubal surgery and ectopic pregnancy history, as well as manipulation of pregnancy via embryo transplantation. I found this to be an interesting study as many women undergo IVF treatment every year to get pregnant. Prior ectopic pregnancy or tubal surgery may be an important pre-existing condition to consider when applying for IVF treatments.
FM Self Reflection: My third rotation wound up being Family Medicine due to the COVID-19 situation, as my previous two rotations would have been hospital-based. The months after March were some of the most stressful and unprecedented times anyone could have imagined, and the effect it had on my experience this rotation was significant. Because of the COVID pandemic, most offices closed or stopped seeing any ill patients. This was true of the office where I did my rotation as well. Many rules for the safety of patients and staff were implemented, ill patients were not seen at all and the office was only open for a few days a week. Also, all staff and all patients had to wear a mask of some kind for safety. Despite these conditions, patients were still seen and the days I was there were full and busy. All the patients I saw were only there for well-visits, medication refills, or routine lab work. While I didn’t get to see ill patients, I was still able to experience patients with chronic conditions such as hypertension, heart failure, and diabetes. I felt that the experience I gained is very important for my future career as a PA. With these particular chronic conditions being so prevalent amongst the patients I saw, I was able to work on my approach toward the management of these ailments and proper patient education.
We also performed COVID antibody testing at the office and I was able to speak to the patients who had fallen ill or had loved ones who suffered through contracting COVID-19. It was surreal to hear these patients talk about how they didn’t have the choice to stay home and quarantine because of obligations to jobs or for other reasons. Also, it was interesting to speak to those who were afraid of contracting the virus and had not left their houses more than a handful of times between March and when I saw them. What I found distressing though, was how much some of these patients valued and relied on community programs for socialization and exercise and were unable to be active because of the COVID closures.
The experience I had this rotation was extremely valuable and I appreciated the many different types of patients I was able to help and treat, as well as hearing their stories or how their lives. I think that I learned so much about common chronic ailments and how to help patients manage their lives while living with these diseases.
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