Two months in Family
Medicine/Primary Care One month to go
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| FAMILY MEDICINE |
Family medicine is a
change of pace compared to my last rotations. It has expanded my knowledge on
what I thought medicine was. In family medicine a lot of what it comprises of
is preventative medicine, holistic medicine, patient education and building a
strong patient-provider relationship. I’ve
been fortunate enough to have a working physician assistant who has graduated
from the same program at my rotation site. I’ve been able to see what our role
is as a working physician assistant and most importantly our potential.
A TYPICAL DAY
7:00 am – HOSPITAL ROUNDS –
We round on our patients who have been admitted. I would see patients with the
doctor and PA and write progress notes. I have dictated admission history and
physicals as well as discharge letters.
9:30am – 4pm or 5:30 pm depending on the schedule
CLINIC: During Clinic I see patients
and introduce myself and do my H&P. The doc likes what he termed “max
packing” going through each of the issues on the patient’s problem list. With
the introduction of the EMR (electronic medical records) everything is computerized.
This allows us to go through the patient’s history and issue list at each
visit. This maximizes the visit to minimize the need for the patient to return.
After I go through the patient’s issues I continue with my exam and wait to
present to the doctor. I try my best to come up with a differential and plan
and we discuss it together.
TASKS: This includes calling patients
who need to come in for follow up appointments or need lab work done. I’ve
reviewed faxed prescription refills. I’ve also done a small data collection
project on breast cancer survivorship and a quality improvement checklist for
a patient admitted to hospital.
NURSING HOME ROUNDS (once a week) - We
visit patients in the nursing home who have had issues during the week and look
over pending lab work. You learn the difference on how you would medically
treat patients in nursing homes compared to those in the community. In the
nursing home most management is conservative and for comfort. Invasive
treatments or investigations are not usually done.
HOME VISITS (~ once every two weeks) – When
I learned we did house visits I was shocked. I thought this was what was only
done in the olden days. Since our clinic has a physician assistant, the PA goes
out to do the home visit while the doctor can continue to see patients at
clinic. I’ve gone with the PA to different patient’s homes in the community. We
see patients who are unable to transport themselves to the clinic. We also see
patient’s at home who are palliative and discuss end life decisions. This
prevents/decreases the number of vulnerable patients presenting to emergency
and subsequently admission to hospital. Home visits are fun. It is very heart
warming and the patients are very appreciative. 
INTERPROFESSIONAL MEETINGS: In hospital when
a patient needs help planning for discharge a meeting is held with different
health care professionals. I was able to sit in a few of these meetings. Those
present in the meetings include us (physician assistant), home care, social
work, occupational therapy, physiotherapy, nursing, the family and the patient.
There is a very strong force that can be felt when all these professionals get
together to come up with a plan.
WHAT I’VE SEEN/DONE/TREATED
Depression/Anxiety
Pneumonia
Hypertension
management
Diabetes
Shingles
Biopsy
with cauterization
Punch
biopsy
Suturing
Women’s
Health - Pap smears, mammogram results
Pre-natal
exams
Well
baby exams
Sinusitis
Cellulitis
DVT
Pain –
pain management
PFT –
pulmonary function tests
EKG
Vaccinations
– Flu, shingles, Hep A/B, typhoid, Tetanus
Herpes
BCC – basal
cell carcinomas
Seborrheic
keratosis
Warfarin/Coumadin
management
Prescription
refills
Bone
Health – Vit D, bone density results
Smoking
Consults
– gyn, physio, gastro, x-rays, ultrasounds etc.
Diverticulitis
Trigeminal
Neuralgia
Kidney
stone
I am
missing a lot! :P These are what I first thought of.
LEARNING POINTS
I’ve learned
that there are a lot of community resources out there which would benefit
different patients. The hard thing is to determine and remember what is
available for them. As providers we are there to guide and connect them to the care they need. This ensures patients have support and optimized treatment.
I also learned that medicine needs participation from both the provider and the
patient. It is important to have a patient motivated and participating in their
own care/management.
Overall this rotation has been awesome so far. I thank my doctor and PA for doing their best to teach me :)
