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 :)

 

The Capstone Project begins...

Happy New Year! Welcome to 2014

It has been a while since my last post. The holidays has come and gone. Although I wish I could say that I got a lot done over the break, what I can admit is that I had some time to relax and spend time with my friends and family.

CAPSTONE

The one thing that our class had to get started on before the holiday break was our capstone project. The capstone project in our program is similar to a “mini thesis”. We decide on a research topic. We are paired up with a mentor who advises us how to approach our topic of interest. We then have to submit a scientific paper (5000 to 7500 words) and give a 15 min presentation. The main goal of the capstone project is to increase and demonstrate knowledge in qualitative and quantitative research concepts and methodologies. 

Our first draft of our paper is due at the beginning of March :S

I am currently doing my capstone project about emergency physician assistants. I am interviewing physician assistants who are working in emergency medicine that have graduated from either U of M or Canadian Forces to learn their current practices. We will use the information to adapt our courses/program to further prepare graduates to work in emergency medicine. So far this has been a fun and exciting project. Learning from past graduates gives me insight on what to look forward to after graduation. 

ACADEMIC DAYS

First day back from the break we gave presentations to the first years about our clinical experiences. I look back to what I wrote on my blog posting in Jan 2013 when the 2^nd years gave us the same presentations and I didn’t know anything about what they talked about. I couldn’t get a good read on what the 1^st years thought about our presentations this year. I tried to make mine simple knowing how I was in their shoes just a year ago. I also realzed how much I have learned since then.

Second day back we had clinical skills formative examinations with the 1^st year PA students acting as our patients. This turned out to be a very fun experience. It was easier and quicker than our last clinical exam last year before clinical rotations. Again this gave some piece of mind that we have learned some things :P

Lastly the day before heading back to our rotations we had an orientation to anesthesia. This was a great overview on what to expect during the rotation. We learned what drugs they commonly use and had some practice on IVs and intubation.

NOV 27, CANADIAN PHYSICIAN ASSISTANT DAY

This was a late post but I thought I would blub on it. The first year PA students had a blast this year going out to different high schools in Winnipeg. The first year PA class gave presentations to the students about the physician assistant profession as well as gave them opportunity to try some hands on stuff ie. play with stethoscopes and other equipment. Unfortunately I was unable to join them and therefore don’t have pictures.

The University of Manitoba also held a small event with lots of yummy food and to honour Dr. Bellas. Dr. Bellas is responsible for our adult medicine course and our internal medicine rotation. He has been an excellent guide for us at the U of M PA program, teaching medicine as well as life’s lessons.  

Anyone recognize the people on the poster? :P That's right it's Ryan and Ritika

I like candid photos. Here are the students sitting and eating while the staff stands in the background :)