Mid Rotation site evaluation:

For the mid-site evaluation, I presented a patient who came for initial prenatal visits. I decided to do this case because OB H&P is different compared to other departments. I was struggling to present the patient in an effective and coherent fashion as the History included more OB. However, PA Melendez was really helpful and amazing critique, who suggested presenting the patient’s pertinent story relevant to her current pregnancy. Also, he suggested ways I could have elaborated on the plan as the patient was experiencing morning sickness and there are few methods that could ease the patient’s symptoms. For example, before getting up in the morning from the bed, the patient can be advised to have some dry crackers, have small meals throughout the day and avoid greasy foods. Presenting this case was a learning moment and now hopefully in the future I can present a OB patient in more effective and concise manner. Furthermore, I choose to present drugs that I have seen being administered in the clinic by the different providers which made the learning process more practical.

End of rotation site evaluation:

During the didactic year, I heard stories of complex patients, but I did not imagine experiencing this complex case.  I presented a young lady whose symptoms and imaging studies indicated appendicitis but a piece of the patient story points toward PID. The surgery team did not want to admit the patient and wanted a GYN to consult while our GYN team through the patient story correlates more with the surgical consult for a ruptured appendix. The H&P was very complex as the patient had a complex PMHx and current presenting symptoms were long listed. Therefore, I was struggling to present the information in chronological order. PA Melendez recommended to concise the history of present illness because it will help to keep the reader focus on the story. I presented the HIP as a response toward the surgery team explaining why the GYN team believes the patient has a surgical emergency rather than a GYN diagnosis. However, PA Melendez suggested only presenting patient current complaints because it makes the complex story easier to follow and understand. Overall, the site evaluation with PA Melendez was learning moments of how to present a patient in an effective manner without losing the audience.