Rotation Summary

Looking back on my first rotation, I feel thankful that I gained such a good foundation in beginning my career as a physician assistant. At my ambulatory medicine site, my main role consisted of bringing patient’s in, obtaining their history and physical and reported back to the doctor to continue with the treatment plan. One thing I was happy to discover was my ability to talk with patients about often very intimate details of their lives- obtaining a sexual history, screening for depression and be able to maintain a level of professionalism while still being empathetic and caring. It came as a surprise to me how early on I was faced with patients sharing so candidly with me, but I was pleased with natural it felt to listen in an open nonjudgmental way. I am sure there is much growth to be done in perfecting my counseling skills but this site gave me a really great opportunity to start early and feel comfortable in my role.
I also feel very thankful with how much practice I got doing a physical exam. Looking back at PD lab with how I fiddled with the stethoscope and awkwardly put on a blood pressure cuff, it’s really rewarding to see how with every physical exam it becomes easier to feel comfortable with my own flow, with explaining different parts to the patient, and most importantly being able to identify abnormal findings.
My first rotation felt like an exciting first step in my career as PA, finally being able to see things not outside of the vacuum of a classroom. I finally felt like all the information that’s been filed away in my brain over the past year and half was coming to life and I was able to gain a better handle on the content.

One aspect of my first rotation which I think perhaps speaks to the patient population was the lack of compliance. I was surprised by how little some patients knew about their own health and in some cases, how uninvested they seemed. After learning that sometimes these patients require a little more patience, it was really rewarding to talk to them and give them as much education I could about how to manage their conditions. Often, patients’ lack of compliance comes from their lack of understanding of their health, which was interesting to learn.

Something that I hope to work on as rotations continue is to make sure I ask a lot of questions. I realized there were times when I felt reluctant to ask certain questions or there were times when the office was just to busy to ask, however every time I did I felt satisfied about how much I learned about a certain topic or disease process. It’s important to make sure that I keep track of all the questions that come up to research and ask my preceptor about in order to solidify my understanding.

Here is a record of the patients I saw on my Ambulatory Medicine Rotation Case Logs1

Site Evaluation

Reflection

At my first site visit, I presented a case about a 21 year-old female with joint pain and hepatomegaly.  The patient was ultimately referred to rheumatology to be evaluated for a rheumatologic pathology causing her joint pain.  At my second visit I presented a case about a 42 year-old male with DM II complaining of flank pain and erectile dysfunction. My site evaluator feedback was that I did a good job presenting my patients and coming up with a list of differentials, but for my next evaluation I should know my pharm cards better and provide more information when presenting my article. I really enjoyed my site visits and hearing about my classmates experiences and listening to their cases.

Journal Article

At my final site evaluation, I presented an article related to a patient I discussed.  This patient had poor glycemic control and had a new complaint of erectile dysfunction.

Article Summary 

This study was a systematic review that included 3299 men with type 2 diabetes aged 27 to 85 years with erectile dysfunction.  Data was extracted from studies on the prevalence of ED among type diabetic patients and the correlation between glycemic control and other risk factors with ED. Three of the studies found a positive association between ED and glycemic control while one study found a weak association. The study concluded that the risk of ED is higher in type 2 diabetic men with poor glycemic control than those with good control.  This study raises the importance of early screening of ED among diabetic men and the importance of HBA1c control in reducing DM complications.

Here is the attachment for the full article: Poor Glycemic Control and ED

Additionally I presented a patient, for which the history and physical can be accessed. HP Rotation 1