During my ambulatory medicine rotation, I was evaluated by Fahim Sadat. For our mid-rotation evaluation, we were required to present one case and five drug cards. I presented a case involving a 38-year-old female patient who complained of fever and vomiting for two days. On physical examination, she had tenderness to light palpation in her right lower quadrant, so we decided to send her to the ER for imaging to rule out appendicitis. For the plan section, I included the steps that would be taken at the ER to rule out appendicitis, as no treatment was provided in the office. After my presentation, we discussed the criteria for ordering CT scans with and without contrast, which was particularly helpful as I will need to make these decisions during my upcoming ER rotation. I was also asked to explain the rationale behind performing an ESR blood test for appendicitis. Additionally, we reviewed common causes of abdominal pain and urinary tract infections. During this site visit, we had many valuable discussions about patient management, the mechanisms of action of various medications, and when to treat patients prophylactically. Moving forward, I will ensure to mention how I would order a CT scan in similar situations.

For my final site evaluation, I presented a case on viral acute sinusitis. The patient had been experiencing a headache, nasal congestion, clear nasal discharge, and sinus pressure for three days. We treated the patient’s symptoms and provided recommendations of things they can do at home to alleviate their discomfort. The site evaluator discussed the lack of evidence supporting the effectiveness of Mucinex in thinning mucus, despite its advertising claims. We then discussed the most commonly affected sinus in sinusitis cases. Additionally, the evaluator emphasized advising patients to take their allergy medications early in the morning before exposure to allergens. Next, I presented an article on the efficacy of intranasal corticosteroids combined with antibiotics for acute sinusitis. The article concluded that this combination is highly effective in alleviating facial pain and congestion, better than both placebo and antibiotics alone. The site evaluator mentioned that intranasal corticosteroids are not typically prescribed and suggested that oral corticosteroids, like prednisone, might be a better option if deemed necessary for the patient.

I found the site visits during this rotation to be very helpful. The evaluator asked many questions and we had in-depth discussions that I learned alot from. For future site visits, I will place greater emphasis on the plan and patient education sections. We discussed the importance of understanding how a medication works and adhering to the instructions provided. For instance, if a patient presents with allergy symptoms, we should advise them to take their allergy medication in the morning rather than later in the day. Additionally, it’s beneficial to review the efficacy of frequently prescribed medications to ensure their effectiveness. Moving forward, I will also make it a priority to thoroughly understand the diagnoses given to patients, including common causative organisms.