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

I found it challenging to manage patients who presented with multiple complaints during interviews. Some patients did not have a primary care provider or insurance and came to the ER for both acute and chronic issues at one time. It can be difficult to address all their needs, treat everything and still ensure that emergent diagnoses are ruled out. However, we can refer them to other specialists for follow-up on their non-emergent concerns. During this rotation, I learned how to guide patients toward focusing on their most immediate concerns while ruling out any life-threatening conditions. We can ask them, ‘What brought you to the ER today?’ or ‘What is bothering you the most?’ At the same time, we want to ensure the patient feels heard and cared for. Sometimes, patients just need education and guidance to connect with the appropriate resources. 

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

In my future rotations, I want to focus on writing more HPIs and condensing them to make them both informative and accurate. During my emergency medicine rotation, many PAs I worked with told me to write an HPI for them after seeing each patient, emphasizing that this is a big part of being a provider. Before this, in most of my other rotations, I primarily presented my HPIs verbally. In some rotations, like surgery or long-term care, it is difficult to practice writing HPIs because patients are usually there for a while and aren’t coming in with new complaints. When I reviewed the HPIs written by others, I noticed they were concise and to the point, yet still contained all the necessary information. While my HPIs were thorough, they were often too long and included unnecessary details. In my next rotation, I plan to practice writing more HPIs because I will have the opportunity to see many patients in internal medicine. I will also ask for feedback from the PA I am working with. With practice, I will become more efficient at summarizing key information, make sure my HPIs are concise and well-organized without leaving out important details.

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

During this rotation, I found it challenging to gather an HPI from patients presenting with symptoms like dizziness and lightheadedness, as these are often very general. It’s important to know which questions to ask to obtain the pertinent history since these symptoms don’t always fit into the OLDCARTs format. For example, because dizziness may be related to cardiac issues, we can ask about associated symptoms like chest pain or shortness of breath. In the ER, I encountered many patients with dizziness and lightheadedness, so it was important to take a thorough history in order to present the case accurately and develop good differentials. I improved at this throughout the rotation, but there is always room for growth. In future rotations, I plan to continue improving my interviewing skills with these complaints. Keeping a checklist for general complaints helps me make sure that nothing is overlooked.

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

A memorable experience during this rotation involved a trauma victim who arrived with multiple stab wounds. Despite QHC not being a trauma center, the acute care team worked together to stabilize the patient before transferring him to another hospital.This was the first time I witnessed a trauma case firsthand and observed how the situation was managed. I was amazed to see more than 10 people immediately get into action, each knowing exactly what to do without being directed. There was no miscommunication or hesitation, everyone understood their role and shared the common goal of stabilizing the patient and stopping the bleeding. I noticed one provider tying another’s gown without being asked, since he noticed it was coming off and being in his way. Teamwork is an important part of healthcare and it becomes even more critical in situations like this. As a student and a future provider, it is important for me to always know my role within the team and do whatever I can to help the patient.