Rotation #5 - Family Medicine/ Primary Care

Two months in Family Medicine/Primary Care One month to go

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 :)