Summary 

This past rotation I was in a family medicine office.  The office was fast paced with a high volume of patients.  Over the time there, I worked with three different physician assistants and two doctors.  The patients were from a variety of backgrounds so I got to meet a lot of different personalities with varying levels of medical literacy.

I think what was most remarkable about this rotation for me was the opportunity to transition from student to more of provider role.  Every provider I worked with requested that I devise a plan for the patient before being seen by the PA or doctor. Over the course of the past few weeks, I became more confident in my thought process presenting the plan to the provider and discussing any alternatives. When I think about graduating in a few short months, I feel a little intimidated by being responsible for the treatment, however the past few weeks I have grown more comfortable with my intuition.

Additionally, because many patients had limited knowledge regarding medicine, I had a lot of opportunities to educate patients on certain conditions.  I can’t count the number of times a patient listened to me explain a simple concept like why they should be cognizant about their elevated blood pressure and responded by saying “wow, you’re the first person to really explain that to me.”  Moments like these have been the most rewarding parts of my rotations it is clear to me that a simple two minute explanation can be exponentially more vital in treatment than a prescription.

Overall, my experience on this past rotation was extremely rewarding and made me feel more prepared going forward in my education.  One thing I think I can improve is acclimating to the flow of a different office or care setting faster.  Part of rotations I find challenging is getting used the different routines at each site over short time period. I hope I continue to get better on acclimating to new systems and routine more quickly.

Here is a log of the patients I saw Case logs6

Site Evaluation 

Reflection

At my site evaluation, I presented one history and physical about a case of a patient with h. pylori and another case about a patient with venous insufficiency.  I think I did a good job on these presentations.  I did a good job presenting these cases. What I enjoyed the most about these site elevations is the opportunity we had to discuss each case.  After each student presented we had a discussion about each one, the presentation and traditional treatment.  I definitely found  that portion of the site evaluation to be most helpful and informative.

Here is the history and physical I presented HP Rotation 6

Journal Article 

Summary 

Helicobacter pylori Infection

The article I presented at the site evaluation provided an overview of the treatment of h. pylori infection.  The main points were that h. pylori testing is recommended for patients with a history of PUD, gastric cancer, or MALToma, as well as patients with dyspepsia, long term NSAID use, or iron-deficient anemia or immune thrombocytopenia.  More invasive screening like endoscopic guided biopsies are recommended for patients with a history of PUD, gastric cancer, or MALToma.  Screening like the urea breath test and stool antigen test would be sufficient for patients with a history of dyspepsia, long term NSAID use, or iron-deficient anemia or immune thrombocytopenia.  In terms of urea breath test versus stool antigen test, the American College of Gastroenterology do not recommend one test over the other, however they point out that the stool test is cheaper.  While the Maastricht V-Florence guidelines prefer the breath test over stool antigen test because of the it is more accurate.  It is important to note that PPIs should not be discontinued 30 days prior to treatment, while histamine blockers can be continued.

While there are numerous appropriate treatment regiments, the most commonly used is the clarithromycin triple therapy which includes clarithromycin, amoxicillin and a PPI.  In patients with penicillin allergies, amoxicillin can be swapped out for metronidazole.  Another common therapy is the Bismuth-based quadruple therapy which includes a PPI, bismuth, tetracycline and nitroimidazole.  Other therapies will be considered in patients with infections resistant to above therapies. Additionally, 1 month after treatment patient must repeat screening to confirm eradication of the infection.

Here is the original article H. pylori