1) Types of patients you found challenging in this rotation and what you learned about dealing with them

Some patients I found challenging are those with extensive medical histories. Since this is a primary care setting, some patients have been seeing the doctor for over 14 years, and the doctor knows everyone’s medical history. When she sees these patients, she already knows how to manage them better. For example, if someone comes in with abdominal pain, she remembers when they came in with similar complaints in the past and knows she needs to create a different plan for them. When I see the patients, I am seeing them for the first time, and it was hard for me to fully understand their complaints and create a plan for them because everything was like a first time visit. The patients also do not tell you everything because they assume we know their history and previous complaints already. As the rotation progressed, I learned to do a quick chart review of their previous visits before bringing them into the room and then take my time to get a good HPI. I let the patient know that I am a student and that I need to ask them a few more questions to get the full picture. Taking my time with the patient and creating that connection helped me manage them better and discuss a good plan for the patient with the doctor.

2) What do you want to improve on for the following rotations? What is your action plan to accomplish that?

In future rotations, I want to become better at interpreting blood and imaging results and knowing the appropriate next steps for the patient. Throughout this rotation, many patients came in to review blood, ultrasound, X-ray, and MRI results with the doctor. After I discussed the results with them, I had to either refer them to specific specialties, such as urology for kidney stones, or give them lifestyle modification advice, such as consuming less fatty foods. This was the first rotation where I had to create a plan for the patient based on their results. Initially, I was not confident in my plans, but as the rotation progressed my confidence grew. However, interpreting imaging results remained challenging for me. For example, if a patient had a thickening of their carotid artery, I found it difficult to determine the next steps without consulting the doctor first and asking for help. My action plan is to interpret more results in my future rotations, such as during my emergency medicine rotation and discuss with the doctor what we would do next for the patient. By seeing more examples, I can start to pick up on patterns and become more confident in interpreting results. I also plan to do my own research on the usual steps taken for certain findings, such as referring a patient for a large kidney stone compared to conservative treatment for smaller stones.

3) Skills or situations that are difficult for you (e.g. presentations, focused H&Ps, performing specific types of procedures or specialized interview/pt. education situations) and how you can get better at them

Throughout this rotation, I had difficulty performing breast exams and distinguishing lung sounds other than normal and wheezing. Even though I performed many breast exams, I often missed some abnormalities such as less palpable nodules. Regarding lung sounds, I was mostly able to differentiate wheezing from normal. Going forward, I will definitely practice more breast exams whenever possible in future rotations and gradually improve my ability to identify abnormalities. For lung sounds, I think it would be helpful to listen to different lung sounds on YouTube to pick up on the differences. In future rotations, such as my ER rotation, if a patient has decreased lung sounds, rales, rhonchi, or crackles, I will take the time to carefully listen to their lungs so I can learn what abnormal sounds like.

4) What was a memorable patient or experience that I’ll carry with me?

One memorable patient I had was a patient who came in for head MRI results after experiencing daily headaches and blurry vision for two months. The imaging results showed a tumor in his temporal area, which could be cancerous or due to metastasis. This was obviously difficult news to deliver and I had never had to give bad news to a patient or witnessed it being delivered before. I learned a lot by being in the room and listening to the doctor explain the results to the patient. She was prepared with the necessary referrals even before he even arrived and considered the patient’s transportation needs since he did not drive. She was empathetic, took her time and was ready to discuss the plan going forward. Although the patient did not become emotional, he had many questions and the doctor took her time to answer them. Witnessing this interaction provided me with a perfect example of how to deliver bad news to a patient in the future which I will always carry with me.