For my sixth rotation, I worked at Centers Urgent Care to complete my Ambulatory Medicine assignment.  I wasn’t sure what to expect with this rotation because my prior experience with Ambulatory Medicine was in a day-center, which is quite different from the Urgent care setting.  I worked with one PA throughout this rotation and followed his schedule for the five week period across two different locations – Brooklyn & Queens.  The two locations were quite different in the way they ran and the hours and often times had a variety of different presenting illnesses across the offices.  In both locations, I was immediately integrated into the team and was responsible for seeing patients, presenting cases and writing notes.

During this rotation, I really wanted to work on my ability of completing a thorough focused exam.  I think there is a fine art to doing this and will continue to work on this as I move through my rotations.  A full physical exam is not required in the urgent care setting but there are definitely accompanying exams that help to rule in / out various symptoms.  Throughout this rotation, I saw many patients complaining of sore throats and understand the abdominal discomfort associated with strep pharyngitis.  We also had patients coming in complaining of one symptom and they left with various diagnoses that were unsuspected.  Most significantly, we had a pediatric patient present complaining of nausea and a headache and on exam this patient had all four special tests for appendicitis.  This was surprising to me given his presenting symptoms but given the findings on exam we referred the patient (and parents) to the emergency room for further evaluation and testing.

I worked to build a nice rapport with the Physician Assistant I was assigned to work with throughout this rotation and felt I earned his trust with each shift I worked.  Sharjeel was very helpful in reviewing medications and their indications and worked with me to review second line indications if there was a patient that was presenting with more than one chief complaint.  He was very knowledgable of the various medications we were utilizing and shared that information with me to ensure I was as prepared as possible when leaving this rotation.  The Queens location has a relationship with various companies, where they must come to have pre-employment testing completed.  While I was working, I was also responsible for completing full physical exams and PPDs for these patients.  It was a great way hone the skills I’d worked on during my Family Medicine rotation and apply them in a different clinical setting.

Given we were in an urgent care setting, I wanted to work on my presentation to my clinical preceptor to ensure I was concise but still provided all of the pertinent information.  The presentations would in theory be shorter given patients are coming for one specific issue and I wanted my update to Sharjeel to reflect that factor.  I think I did better with this skill as I progressed throughout the rotation and was very hyper-aware of this fact throughout my rotation as it was something I was making a conscious effort to improve upon.

Often throughout this rotation I was surprised to see how many patients came to Urgent Care for chronic issues or for issues that should have clearly gone to the Emergency Room.  On several occasions, I saw patients that presented with complaints of pain / issues going on for 6-12 months and they picked a random evening to come in for evaluation at an Urgent Care setting.  On the other hand there were a few cases where patients came in with troubling issues that we referred directly to the Emergency Room, including STEMI, Pneumothorax and Mastoiditis.  What was surprising to me in the case of Mastoiditis is that this was the patient’s second time having this medical issue and he refused an ambulance / going to the ED and asked to be treated with medication, especially after we explained the potential side effects of Mastoiditis.

As I move into my next rotation, I will continue to hone my medication management and ensure I am as up to date as possible as to the various medications needed to treat complaints.  This rotation was helpful of my patience (which is not one of my strong suits) in trying to get patients to share their chief complaint, move them through their visit but also ensure they feel treated and cared for at the end of their visit.  I also thought this was a good opportunity to learn ‘my role’ in the greater medical landscape.  I was offering to do a lot of the different tasks as the student but did not want to overstep as other people were there hired to do those roles.  I, often, feel awkward for asking for things even though that is the appropriate course of action and this was a great opportunity for me to work in the setting as the provider.

This rotation was a great learning opportunity and I was very fortunate to have worked with a PA that let me see patients and present a plan and treatment options.  I will utilize the skills I learned throughout this rotation as I continue my clinical year and apply them in my rotations moving forward.

This entry is licensed under a Creative Commons CC0 1.0 Universal Public Domain Dedication license.