History & Physical:

Fam Med H&P 1

 

Site Evaluation Presentation Summary:

For my site evaluation, I submitted 2 H&Ps but presented my first H&P which was on a 21-year-old obese female patient presenting with a chief complaint of having elevated blood pressure readings many times with previous providers but never following up so she came to establish care and take care of it. Lab results and differentials were then discussed, and I realized I had more to consider for the patient than I originally thought. I then presented my journal article which was relevant to H&P #2 for a patient with chronic knee pain alleviated by heat packs. My journal article was an RCT related to this and discussed below.

 

Journal Article & Summary:

Use_of_Low_Level_of_Continuous_Heat_as_an_Adjunct

This article is an RCT that was done to evaluate the use of low level of continuous heat (LLCH) as an adjunct to physical therapy to see if it improves knee pain recovery and compliance for home exercise in patients with chronic knee pain. 50 patients with chronic nonspecific knee pain were randomly allocated to an LLCH group and a placebo group. All subjects underwent 1 hour of conventional physical therapy which included thermotherapy, joint mobility, stretching, isometric exercise, and postural exercise twice per week for 2 weeks at the outpatient clinic. In addition to that, they were asked to accomplish 1 hour of therapeutic exercise which included stretching and exercise at home each day they were not in the clinic. All subjects in the LLCH group were given a commercially available, over-the-counter, LLCH pack (ThermaCare) which they would apply to their sore knee 6 hours before they performed their home exercise each day they were not in therapy. The control group took what they thought was ibuprofen but was a placebo dosage so that the placebo effect could be seen in this group. This was done because placebo heat is impossible to use, since subjects would notice that the wraps were cold. All groups were evaluated each week. They were given home exercise and heat compliance logs and a visual analog scale (VAS) for pain to be filled out each night before exercise and, if they used heat, before and after the heat was applied. Before, during, and after intervention, pain intensity, active range of motion of the knee (AROM), knee strength, and home exercise compliance were measured. LLCH group showed pain reduction after 2 weeks of therapy sessions.  AROM and strength of the knee significantly improved over time compared to the placebo group. Home exercise compliance was significantly higher in the LLCH group than placebo group. These results indicated that the use of LLCH as an adjunct to conventional physical therapy for chronic knee pain significantly improved pain attenuation and recovery of strength and movement in patients with chronic knee pain.

 

Typhon:

Family Medicine Typhon Log

 

Self-Reflection:

Starting this rotation, I was curious to see how I would feel about working outpatient and looking forward to seeing if family medicine was something I want to do. However, this was not the case. It was my least favorite rotation and I’m not sure if it was because I did not like “family medicine” or if it was the location I was at. Although the staff there was nice and friendly, I felt very lost the entire 5 weeks because I was not familiar with eClinicalWorks and there’s no “training period” for the system or which lab you send bloodwork to based on the patient’s insurance or how things flow in the office. I found it frustrating and disorganized for the most part and there was not much “teaching” involved, which I didn’t like. I felt like there were always too many patients booked for one time slot and this made it hard to take my time to learn anything or ask any questions.

I think the types of patients I came across this rotation were some of the toughest to deal with. I felt like 50% of the patients answered “I don’t know” or “You tell me” or “I had an appointment, but I don’t know for what” when I asked them what brought them in today. This was very frustrating to deal with because this made the visit take longer because I now had to go through the patient’s chart and see previous visits and what took place. Even the, sometimes it was still no clear why they were at the doctor’s office and what they needed since they didn’t even know. This made me have to go to the rest of the staff to see if they knew why the patient was here and if they did, I would get even more frustrated because they could have dealt with this patient over a different one that I could have helped instead. Although this was frustrating to deal with, it made realize how big an issue health literacy is in this patient population. Another issue I faced on this rotation, was patient’s that had no patience for students and just wanted to see the doctor only. One example happened very early on in my rotation.

On my second day, I had to deal with my least favorite type of patient/person- the type that can’t stand students. She was a 68-year-old female that was relatively new to the clinic since it was only her second time coming to the clinic. When she came into the room, I began asking her the standard questions, being that it is my first time meeting her, and she answered every question with “It should be in the computer there, why are you asking me this?” and she seemed annoyed with me. I started looking through the chart to familiarize myself with her case without having to ask her too many questions and she still kept questioning me on what I was doing. I informed her that I was new and just wanted to get familiar with the system and patients. When I realized she was going to be a difficult patient, I stopped asking questions and continued with entering the ROS and Physical Exam templates to get them set up for the doctor when she comes in. The patient then asked me “What are you doing? Why are you entering anything in the computer? That is the doctor’s job”. I then stopped what I was doing and told her I was going to get the doctor, for which she replied, “Finally, thank you!” When the doctor went in to see her and closed the door, I stayed outside in the hallway and heard the patient complain to the doctor about me and the fact that I was reading her chart, asking her questions, and complained about everything I did. The doctor then explained to her that I was a student and that was my job. The patient then said, “I have never had to deal with this before, I will not be returning here for care,” and she left the room and the office. This was the most awkward and upsetting situation I had been through in my clinical year and it made me realize there will always be patients that complain or are never satisfied.

Even though I did not have a great experience at this place, it did expose me to somethings other rotations did not, like charting/documentation. I learned how much I hate this part of the job. Although this could have been because I did not get training or told which features in the chart the doctor likes to make sure she includes and which parts are not necessary, at least for the student to fill out. It also got me exposed to writing prescriptions and considering what medications the patient is already on and why you can/can’t give a certain medication. It also brought medication dosing to my attention and made me realize this is something that we, as new-grads, will have to start knowing pretty well. Lastly, I got more venipuncture practice on this rotation, which I think I improved on since the start of the rotation year.

Overall, I did not enjoy this rotation as much as the others, but it taught me what I don’t like and what I don’t want to do.