Mid Rotation site evaluation:

For the mid-site evaluation, I presented a patient who came to the office complaining of left breast pain and a mass. I presented this patient because breast cancer is a common finding among women therefore it is very important to be able to identify effectively. For this patient, considering her age and presentation, I was more leaning toward fibroadenoma than breast carcinoma. PA Mohamed agreed with the list of differentials and he suggested to explicitly write out that I had chaperon during the breast exam. Also, it is very important to mention, the pertinent positive family history of breast cancer which the patient denies.  PA Mohamed was a really helpful and amazing critique, who suggested ways I could improve my presentation of the H&P by focusing on the pertinent positive. Presenting this case was a learning moment and now hopefully in the future, I can present breast mass patients in a more effective and concise manner. 

 

End of rotation site evaluation:

For the final site evaluation, I presented a patient who came to the office complaining of intermittent chest pain for the past three days. This was a complicated case because the patient had symptoms of MI but he was discharged from the ER a day before presenting to the office. Also, the patient was experiencing severe anxiety, which could be another reason for these presenting symptoms. PA Mohamad provided constructive ways I could formulate the working differential diagnosis. He suggested, in order to rule out the differential diagnosis of PE, I could have used perks criteria, which is an effective tool in justifying the ddx. Furthermore, PA Mohamad recommended to include obesity counseling as a part of the plan because the patient’s BMI was in the obesity range, which is a risk factor for coronary artery disease. Overall, the site evaluated was a positive and judgment-free environment, where I received recommendations to improve the H&P. Furthermore, the article was a very interesting correlation of subclinical hyperthyroidism and the risk of cardiovascular mortality. Site evaluation with PA Mohamed was a great experience.