I greatly enjoyed my family medicine rotation at Amazing Medical Services in Jamaica, Queens. This rotation highlighted for me the important role of primary care physicians. My previous rotation was at urgent care, where patients came in for one specific complaint, were treated, and often did not follow up with the provider after that. In family medicine, most patients came in for multiple, chronic complaints, and had a long and trusting relationship with the doctor.
I got to be present with the patients for their entire visit. I would triage the patients, obtain their full history, conduct a physical exam, and then document my assessment and plan. I would then report my findings and impression to my preceptor, Dr. Dairo. We would then discuss the treatment options and relay them to the patient. This experience really pushed me to be more independent. At first this was quite difficult for me, and I would ask the doctor to recheck my findings because I did not feel confident. However, over the rotation I began to feel that my clinical skills were improving.
Another challenge of this rotation was the fact that most patients had multiple comorbidities that needed to be addressed. Patients were often elderly and obese and had diabetes, hypertension, and osteoarthritis. When these patients came in, I had to remind myself to make sure their lab work and medications were up to date in addition to discussing their chief complaint. I realized that this requires great time management skills. I know that with more practice I will continue to improve my ability to sift through information and address pertinent issues in a timely manner.
I learned a lot about being a hands-on provider from Dr. Dairo. She cares deeply about her patients and took the time to discuss the importance of lifestyle changes such as exercise, eating healthy, and smoking cessation in a way that made the patients feel empowered to change. In one memorable patient encounter, a young woman with depression was anguished because she could not afford her antidepressant medication. Dr. Dairo consoled the woman and offered to pay for her next 90 day supply. In another instance, a 90 year old patient needed help getting from her car to the office, so Dr. Dairo and I went out to escort her. These encounters reminded me that practicing medicine is really about caring for a patient’s well being in whatever way you can.
Site Evaluation Presentation:
I had two virtual site visits with professor PA Alie. For my first evaluation, I prepared an H&P and five pharm cards. I presented them to my professor and a classmate via Zoom. I chose to discuss a patient who had leg pain due to claudication. We talked about the factors that can exacerbate this condition, as well as the treatment options available.It was also very interesting to hear from my classmate about her experience in primary care. She noted that many patients simply come in for medication refills, while others have more complex needs that they want to discuss during the visit.
For my second site visit I prepared two H&Ps, five additional pharm cards, and an article related to my case presentation. I presented a patient who came in for a rash on his hand. This case was a challenge for me, because the patient had schizophrenia, which made it difficult to conduct a thorough history with him. At my site visit we talked about the importance of caring for individuals with different physical and mental needs, and the importance of involving the patient’s care team in the treatment plan. I then presented a research article regarding the efficacy of salt water baths and UVB light for the treatment of chronic plaque psoriasis. My classmate’s presentation and article was very interesting, and I gained a lot from our meeting. Professor Alie was helpful in critiquing my H&Ps and giving me more ideas of differential diagnoses that I could have included.