I had a great experience in Ambulatory Care at Statcare Urgent Care in Crown Heights. On my first day the staff told me “Get ready, because this is Statcare’s busiest office!” and it certainly was. My shifts were 8 AM to 8 PM and we often saw over 150 patients a day. As a student, I was able to use this opportunity to be really hands-on with patients. The providers trusted me to see patients on my own, complete the history and physical exam, and present my findings. I would then discuss my ideas for treatment with my preceptor, put the orders into the EMR, and explain the care plan to the patient. This autonomy helped me gain confidence in my skills and my ability to form a robust list of differentials.
I got to perform many procedures including blood draws, EKGs, impacted cerumen irrigation, wound/burn care, splinter removals, POC glucose checks, subcutaneous and intramuscular injections, and splinting. I also did an abundance of throat swabs to test for strep and nasal swabs to test for COVID-19. I was excited to practice my suturing skills that I had learned during my surgery rotation. I got to place 7 sutures on the forehead of a construction worker who was injured at work. The patient was very appreciative that we were able to do the procedure in the office and I was relieved to see that the laceration was healing well at his follow up visit.
I had a few memorable patient encounters during this rotation. One was a conversation with a patient regarding a positive pregnancy test. The medical assistant let us know that the patient was not sure if she wanted to keep the pregnancy. The provider and I spoke with the patient regarding her feelings and the options she had ahead of her. In the end, the patient stated that she wanted to keep the pregnancy and we were able to send her a prescription for prenatal vitamins and a referral for an OB/GYN. Another patient that stands out was a young man who came in for chest pain.. During the patient interview, he admitted to recreational opioid and cocaine use. The provider spoke with him about the importance of being honest with healthcare providers and giving the full information for each question. We explained to him that we do not ask personal questions to be nosey or judgemental, we simply want to make sure that we understand the full situation.
Because of the high volume of patients, I had to learn to assess a patient and come up with a list of differential diagnoses quickly. This rapid pace was certainly something that took me time to adjust to. I would also like to continue working on developing ideas for supportive care measures that patients can use. When antibiotics are not warranted, patients still want to hear about what they can do to help themselves feel better. Supportive counseling can make patients feel more in control of their situation and give them a more positive experience with their healthcare provider.
Site Evaluation Presentation:
I had two virtual site visits with professor PA Sajid Mohamed. For my first evaluation, I prepared two H&Ps. I presented one of them to my professor and two classmates via Zoom. I chose to discuss a young patient that was complaining of constipation. We talked about the various lifestyle changes and dietary habits that can contribute to this condition. Professor Mohamed also critiqued my H&P and sent me the corrected version after our site visit. I found his advice to recommend an increase in fruits and vegetables in order to boost fiber intake to be very practical. My second H&P was about a 10 year old patient with low grade fever for two weeks. In the HPI I included that the mother noticed a rash over the child’s buttocks. In my differential I listed this skin finding as a possible contact dermatitis. Professor Mohamed also noted that the rash may be secondary to a viral exanthem. This was helpful because it encouraged me to make connections between findings in different body systems and look for a common cause.
It was also very interesting to hear from my classmates about their experiences in urgent care. Some offices tended to get more Covid-19 testing patients, while others had more complaints of ear infections and strep throat. My classmate’s presentation on a patient with a basilar skull fracture was particularly interesting to me. She explained that the patient had previously been evaluated in the ER but they had missed this finding. After examining the patient, the PA sent the patient back to the ER with the instructions to request a head CT. We talked about the importance of advocating for patients and tools for evaluating what level of care they need. Patients often come to urgent care with complaints that are best treated in a hospital setting. This can be for a variety of reasons, including shorter wait times at urgent care, misunderstandings regarding the severity of their condition, or lack of health insurance. We spoke about the importance of providing quality patient care while operating within the scope of the specific medical setting.
For my second site visit I presented a patient who came in for left arm pain and chest pain. This case was unique because the patient was a young man with no previous medical history besides obesity. My professor was impressed that I included a copy of the EKG that was done in the office in my H&P. I then presented a research article regarding the correlation between obesity and CHD in young adults. My classmates’ presentations and articles were also very informative and I gained a lot from our meeting. I think I benefited most from the way the site visit was interactive and judgement free. We were each allowed to ask questions and offer ideas during the presentation.