Mid Rotation site evaluation:

I presented a comprehensive H&P on a patient who presented with back pain for 1 month, but imaging was suggestive of metastatic cancer. I was struggling to present the patient comprehensive story in a concise way. Also, I was also not sure if I should report the ED finding or the finding that I observed during interacting with the patient. Professor Herel helped me to overcome this challenge by suggesting to present study as a case report rather than just an H&P, meaning it should flow like a story from the start point (ED) to the current course in the (floor). Furthermore, Professor Herel suggested incorporating the imaging and labs report part of the H&P, which I should have included but it a good learning moment and I would not forget this lesson in the future. Additionally, I received feedback on how to present the review of the system in a concise way and easier for reader to follow. I really like the pharm card was presentation because it encouraged me to learn about the most commonly used drug in internal medicine.

 

End of rotation site evaluation:

I tried to incorporate all the advice I received on the mid-evaluation in this comprehensive/ problemed focused H&P in presenting a patient with the symptom of DVT. This patient had PMHx of ALS which provided a chance to learn about the impact of bed boundness on VTE. Also, after discussing the patient, professor Herel suggested looking into May turner syndrome, which was another opportunity to learn that I really enjoyed. I also presented an article on VTE in ALS patient, where I discussed the important finding of the article and drawback of the study.

Pharm card session with professor Herel was very helpful because he had a unique way to connect medication use to everyday life that helped me to remember the medication and think outside the box. For example, I presented Eliquis and he asked “which group of patients we cannot use Eliquis” which was not on my card but he explained the reason to avoid it in valvular a-fib, ESRD and antiphospholipid syndrome patient. Furthermore, I learned why we need to bridge warfarin with heparin, which I found to be really valuable and I think that will help to make my decision in the future. Overall, my site evolution was full of learning and exciting opportunity to explore the horizon of medical practice.