• Types of patients you found challenging in this rotation and what you learned about dealing with them

The type of patients I found challenging are the ones that insist to see the doctor, or specifically Dr. Dairo (my preceptor). They do not want to be seen by anyone else besides Dr. Dairo because they have known Dr. Dairo for so long. I have learned that when dealing with these kind of patients, taking it personally will not help to solve the issue. I will explain the role of a Physician Assistant and that I am still being trained to be a clinician. It is important to be patient and willing to explain that I will be taking their history and doing their physical exam, and then Dr. Dairo will come to see them after. By the time Dr.Dairo comes into the room, I am already done with the history and the physical exam. I understand the trust and bonding between the patients and their primary care provide and therefore I will ensure that I have explained everything that I am doing. At the end, I will get the history from the patient, and the patient will be seen by the doctor too. I believe that I will be dealing with the same kind of patients throughout my future rotations and future career as a PA. I am willing to spend extra time to explain the role of a PA and that they are always welcomed to see a doctor if they want, instead of just walking away and neglecting the patients.

• How your perspective may have changed as a result of this rotation (e.g. elderly patients, kids, IV drug users, etc).

My perspective has changed for elderly patients as a result of this rotation. Before the rotation, I thought elderly patients would be very difficult to manage because they have a lot of complaints. They could be having pain everywhere, couldn’t fall asleep at night, depressed or confused. The most important thing is polypharmacy. Many of them are suffering from multiple chronic disease and on many long-term medications. During the rotation, I have learned that the management for elderly patients are time consuming, but doable. I just have to do everything in a prioritize order and ensure that all the complaints are being taken care off. The electronic medical record system is also very helpful when it comes to drug-drug interaction, and this will be beneficial when dealing with polypharmacy. In future rotation, I will continue my positive attitude towards all different type of patients, regardless of their age. It is also important to consider drug-drug interaction and polypharmacy in all elderly patients.

• How could the knowledge I’ve gained here be applicable in other rotations/disciplines?

In family medicine, there are a lot of patients with diabetes, asthma, hypertension, and hyperlipidemia. I’ve learned a lot from my preceptor about how to manage these types of patients, including drug therapy, lab tests to order, and lifestyle modification. The knowledge of management for these types of patients will be applicable in other rotations because it is important to manage the patient as a whole. There are a lot of patients out there with these conditions and a long list of current medication. Uncontrolled hypertension, diabetes, and hyperlipidemia can lead to a lot of unwanted complications such as cardiovascular disease. We should not overlook the patient’s comorbidity and only treat what is bothering the patient at the moment. As providers, it is important to consider the medications that the patients are taking and ensuring that the patients are compliant to their medications. The management of these diseases will be important in the future rotations because the patient recovering from MVA or multiple fractures should also have his blood pressure and lipid well controlled.

• What do you want to improve on for the following rotations? What is your action plan to accomplish that?

For the following rotations, I would like to expand my experience and knowledge in dermatology. There are plenty of dermatology patients in family medicine, more than what I have expected in the beginning. I often have issues identifying and describing the rash and lesion, as well as coming up with diagnosis and treatment. It is difficult for me to use medical language to describe lesions and rash. My action plan for this is to review old notes from dermatology and see more pictures of rash and lesion. It is also important that in the future rotations, I am willing to spend more time with encountering patients with different rashes and lesions. I believe that the more skin disease I see and get involved with during the clinical, the more I will be able to learn. Hopefully, I will not be struggling to describe rash and lesion for dermatology after my clinical year.

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