RT2-FM-Reflection paper

During 5 weeks rotation at amazing medical service, I learned that it is very important to develop a good relationship with patients in family medicine. Usually patients have been seen by Dr. Dairo (my preceptor) for a long time, they know Dr. Dairo’s style. Dr. Dairo can communicate with them really easy, because she knows the patients for long time. I have to read couple office visit progress notes in order to understand patient’s health condition and chronic issues. Family medicine is about to manage patient for long-term/chronic issues, especially in the elderly patients, like osteoarthritis, psoriasis, hypertension, diabetes, and sciatica. For example, when I asked, is anything other than chief complaints that also brother the patients. Patients will say they have shoulder pain or other long-term issues. I will take the pain as a new complaint and ask OLDCARTS for it, and the patient needs to tell their injury story from beginning. But, Dr. Dairo who knows what happened, and patient feels more comfortable to not to repeat the story again.

For HPI, it is different from what I learned. In the HPI, we addressed the chief complaints patient had. But in this family rotation, I have to address every issue patient had. Every visit, besides the chief complaints, patient’s chronic issues, like hypertension, diabetes, hyperlipidemia, and osteoarthritis, glaucoma, should be include in HPI as well. For each problem that patient had, I need to ask the relate symptoms, patient’s compliance with medications, and monitoring progress, like fingerstick, monitor blood pressure and diet control at home. With more practice working on H&Ps, I get used to put my assessments, also need to add notes on each issue that how is patient doing, and what is the next step. For example, if patient’s blood pressure is not optimally controlled, I should discuss with uncontrolled high blood pressure complications, medication compliance, any diet suggestions, monitoring at home or the need to increase dosage of current medications, or add a new medication to have better control over blood pressure.

For managing DM patients, we need to pay special attention! Anything looks like small, but it can be crucial to them in managing their health! There is one female patient with past medical history of DM type 2 came in on the first week with complaint of swelling and pain on the distal of left lower extremity. She states that she felt down at the edge of step and she used ice to compress the area. Based history provided and physical examination, and doctor prescribed cephalexin. One week after, the patient came in for follow up and complaints worsen pain and swelling on the same area. After detailed history, patient mentioned she used tooth stick to burst it before she came to the office, and she did not tell doctor at the first office visit. Patient ends up to be referred to urgent care to drain the abscess. If the provider knew that patient used tooth stick to burst the swelling at the first visit (high infection risk), and consider that patient has a history of diabetes, a stronger antibiotic will be given, like clindamycin.

For my next ambulatory rotation, I will try to practice on my medical procedure skills beside venipuncture or injections, but focus on IV placement, suture, and I&D. In the family medicine, I saw a lot of patients come for preventive care, and learned management of chronic issues, but I will learn more about more acute complaints and acute management with ambulatory care rotation. For the following rotation, I will observe how clinicians interact with acute complaints, and then how they manage these situations, and then practice on gather concise information that needed for diagnosis and treatment of patient’s acute complaints.

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