Reflection

Rotating at the StatCare-Hicksville site for my Ambulatory rotation was more that I could ask for. When I first began, I was apprehensive about Urgent Cares because of how fast paced the environment is and I was unsure that I would be successful. My first day was nothing short of overwhelming. I was familiar to how quick the patient encounters were, from the interviewing, diagnosing and counseling; but not how hectic it can be seeing patients back to back, for 12 hours. But I kept an open mind, in terms of learning, I wanted to gain as much as I could, and I did make it. I worked alongside MDs, PAs and MAs trying to assist wherever I was needed.  Every day was a new day to challenge myself and learn something new.

In the beginning, I had difficulty presenting my patient cases to the MDs and PAs. Each provider asked different questions and sometimes I had to alter accordingly. I also would have a few minutes with the patient before the provider would see them. So my presentation was very short and it was felt very rushed. And many of the cases I felt I needed more time to process and understand. The providers did a fair job at explaining the patient findings, like what was abnormal versus normal. However, during rush hour it was hard to have the provider stop and explain cases.  For the future, I have to realize that this will most likely happen and I need to better prepare presenting my cases, with a good list of differentials and proper assessment/plans. Also, I shouldn’t hesitate to ask questions about indications for certain medications or courses of action. This skill I will to continue to improve upon.

During my rotations, I learned a lot of valuable clinical skills. On my first day, under the supervision of the MD I administered vaccines. To be honest, I wasn’t very good. I was nervous and it showed. But the provider was very kind to take his time to show me the proper techniques to injecting and even let me give him a Flu vaccine. Soon after I was drawing up vaccines, and administering intramuscular, subcutaneous and even a few intradermal. Another skill I gained at the Urgent Care was venipuncture and blood cultures. Learning on a mannequin arm is quite different from an actual patients arm. For a few days I actually followed the MAs and had them teach me, and then throughout my rotation I was doing blood draws easily. I also learned how to perform rapid flu, strep swabs and throat cultures, because of the season everyone presented with similar symptoms and I did this quite often.  I practiced my EKG, brain scope for head injuries, fluorescein staining, and posterior ankle splints. A few other procedures I performed were a laceration repair above the eye, I sutured a middle finger with instilling a digital nerve block, removing staples, and I also packed a couple of abscesses. Furthermore, I assisted in a GYN-pelvic exam, cauterization of subungual hematomas, and a few I&Ds.

We received a wide variety of patients, from elderly to infants. It was very exclusive which I enjoyed because it allowed me to see different cases. While I was interviewing patients, I learned many of the older populations would be coming for more chronic issues and considered this facility as a primary care. Many of them were diagnosed with hypertension or hyperlipidemia, and we were following up with their cases. This practice also had many Immigration, CDL-DOT exams, and suboxone patients. Through these encounters I learned how to ask and complete focused exams for these patient visits.

One memorable patient I encountered was a 23 year-old male presenting with sharp right sided posterior rib pain that was radiating to the shoulder. We were unclear of the origin of his symptoms, upon questioning he said a few days ago he experienced a motor vehicle crash. From that, we deduced that it was best for him to the the ER and gave him a referral for an X-ray since we lacked the adequate imaging in the office, to rule out possible tension pneumothorax, which was high in our suspicion. In this encounter, I learned that if you don’t know something, you ask, in this situation the patient was sent home by his previous provider, without providing a thorough workup.

In this 5 week rotation, I learned how to think like an Urgent care provider. I began formulating quick non-emergent diagnosis upon my questioning the patient. I did quick thorough history and physicals but still provided complete care. Ultimately, I learned that fast paced environments doesn’t mean you diminish your quality of care, you listen, and provide adequate care within your means. As a provider, if something is urgent, don’t hesitate to send to the Emergency Room and also don’t be bought into patients without proper diagnosis. Overall, I had a great experience here, the providers were very willing to help and teach. I am eager to head onto Family Medicine my next rotation, to gain more clinical knowledge and practice my skills.

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