Rotation Reflection #5 (Emergency Medicine)
Types of patients you found challenging in this rotation and what you learned about dealing with them
The type of patients that I found challenging are the ones that present to the ED with known psychiatric disorders. They are usually not a very good historian which makes it even more difficult for interviewing. They can be so quiet and does not bother to speak with you, or extremely agitated that they would start harming themselves. In these situation, I would often have to rely on the caregiver for most part of the history. But it is still challenging to appropriately manage and accurately assess agitated patients. For the agitated patients, I learn that it is important to maintain a safe environment by getting security and additional staff involved. These patients should not be handled by one provider or one student.
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 IV drug user as a result of this rotation. After this rotation, I become more aware of the IV drug abuser population. IV drug administration can lead to serious health problems. Most drug addictions begin through less direct methods such as ingesting the substances or smoking. But as dependence increases, they begin abusing drugs though IV injection. Skin infections are extremely common due to non-sterile equipment and poor hygiene. They will have developed scarring and needle tracks. IV drug abusers also have a high risk of endocarditis. Sharing needles or failing to properly sanitize the equipment can also lead to direct transmission of blood related condition such as hepatitis and HIV.
How could the knowledge I’ve gained here be applicable in other rotations/disciplines?
During my ER rotation, I have learned to focus on acute care management and critical care, improve differential diagnosis, and also basic procedural skills such as wound care, suturing, splinting. The knowledge that I’ve gained here will be applicable in other rotations because it is always important to recognize life-threatening conditions. We will never know if the patient with gastroenteritis walk into the clinic might turn into an appendicitis, or the patient with chest pain turns into pulmonary embolism. After this rotation, I learn that we should always include these as part of our differential diagnosis.
What do you want to improve on for the following rotations? What is your action plan to accomplish that?
For the following rotation, I would like to improve on coming up with management and treatment plan. Throughout the previous rotations, I often have to rely on my preceptors or the other providers that I am working with. Most of the time, I am still thinking like a student and that I only have to present the case to my preceptor after interviewing the patient. For the following rotations, I would like to start getting used to think like a provider. I am currently more than half way done with my clinical year and soon I will be on my own to set up treatment plans for different patients. After interviewing every patient, I would try to have my own management and treatment plan and I would ask how my plan could have changed or be different in order to provide better health care to the patients.
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