I had my site evaluation on Zoom with professor PA Mohamed. In total, I prepared three H&Ps and a related journal article. I was joined by my classmate who is also rotating in Woodhull ER with me. I chose to discuss a patient who had presented with a COPD exacerbation. This was a challenging case because the patient was undomiciled and not compliant with his medication. We talked about the factors that can cause a COPD exacerbation,  as well as the treatment that can be given to relieve symptoms acutely. I found a related article which studied the effectiveness of different methods to improve medication adherence.I also presented a case of a patient with a kidney stone.

 It was very interesting to hear from my classmate about his experiences. He discussed a patient with chronic kidney disease who had missed his dialysis appointment. His article looked at the patient outcomes and cost effectiveness of providing routine hemodialysis for undocumented immigrants versus only allowing them to receive emergency dialysis once they are already in crisis. The researchers found that it was better for patient outcomes, and less expensive in the long-term, to provide weekly dialysis. 

Throughout the site visit, we focused on the importance of understanding our patient population and tailoring out assessment to the diagnoses that are most common in that area. For example, patients living in rural areas may present more often with tick borne illnesses, while those living in cities with lower SES may not have stable living conditions. I appreciated my professor’s feedback on my H&Ps and article. He brought up many points that are important to keep in mind in the ER. I will continue to work on expanding my list of differentials and the testing that can be done to narrow down the options. 

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