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Tuesday, January 31, 2012

What the Future Brings

As my ER rotation begins to come to an end I can’t help but think MAN this went by so fast. I have enjoyed my time in the ER. I found my time here to be probably the most educational and hands on. I learned how to placing IVs, suture lacerations, splint broken bones, draining abscesses, perform CPR etc. More importantly I learned to evaluate the patient while keeping in mind “what is the worst case scenario” and how do I prevent it from happening. I have had amazing moments and moments so horrible I would never want to relive. Ultimately, I will is miss this rotation and the people I have worked with. In the beginning I thought ER was not my cup of tea, now I am not so sure.

This blog entry is a little different than all my other entries. As my student experience begins to end I can’t help but think about life working as a PA. What specialty will I go into? Where will I practice? In what state? There are so many questions. I have a little less than 6 months to graduate and my answers to all the above questions are “I don’t know.” I thought by now that I would have had some life altering moment where everything became clear and my path would be chosen for me. It is a blessing and a curse that I have loved all of my rotations, I still have 3 to go. I know that this means I have chosen the right profession for myself. Being a PA will allow me to work in multiple different specialties if I so wish. The flexibility was one of the main reasons for choosing the PA profession. I like having this option, however, I never thought I would need to utilize it.

Let me explain further. So far there are pros and cons to every rotation. For example, I enjoy monitoring my patient’s progress over years and seeing them grow. In the ER mostly you ship a patient to other departments. This means you may never see them again and the ultimate outcome may be unknown to you. In primary care it is the opposite you are the “gate keeper”. You need to be aware of symptoms that warrant a trip to the ER. You are in charge of making sure your patients have their colonoscopy at 50 years old if they have no family history or risk factors. You need to make sure you patients take their medication and follow up for blood work to track their progress. Primary care requires a lot of balance and coordination with other specialties. On the plus side there is more time to build a rapport. These examples are just scratching the surface.

As one can see there is a lot to think about for my near future. In the meantime, I am setting up my elective rotation, I have decided on dermatology. I find the skin fascinating and challenging. Dermatology was the first topic in our clinical medicine class and the topic I enjoyed learning the most about. I am a very visual person, rashes you can see and feel. However, it is challenging because some of the dermatologic conditions look alike and subtle differences in a person’s history can change your diagnosis and treatment. Important questions like have you travelled recently? What came first the rash or the fever? or Are there any recent changes in medication? etc are key. At the same time dermatology is not all about rashes, it can be about acne or skin cancer or simple cosmetic issues that affect a person’s daily life. My elective is in June-July, I hope it ends up being a great fit. If I end up not enjoying it I know that it can only benefit me in the future.

Tuesday, January 17, 2012

ER: My first hospital rotation

           I started my ER rotation about two weeks ago and so far it is going well. Out of all my rotations this has been the biggest adjustment for me. I am not used to the “treat them and street them” approach. I am not sure if it is because it is my first rotation in a hospital or if ER is just vastly different from my other primary care rotations. Coming from rural PA, ER seems very fast paced but I enjoy that. I am never sure what will come through the doors. Most of the time, surprisingly there are cases that we consider “non-emergent”. However, I have had some true emergencies, on my second day I performed CPR. Unfortunately, the patient did not make it, and I experienced my first loss. The worst of it is confronting the family. No matter how hard you look at it there really is no easy way to lessen that burden. My preceptor did do an excellent job at telling the family.
       On a happier note, I have really gotten to do a lot on this rotation: sutures, staples, abscess drainage, splinting, cleaning a wound etc. I have also gotten to work with a lot of PAs! In the ER I am working in there is a fast track and the regular ER. The fast track is for cases like broken bones, lacerations, abscesses, and more quick fixes. I like it there the most because I get to work with PAs who have been preparing me more for the regular ER. For example, I have gotten a lot of tips on my presenting skills. For those that are unaware, my job currently is to see a patient, get a full history, do a physical exam and come back and present this to my preceptor or the attending on staff. This is your chance to show your stuff so to speak and make a diagnosis and treatment plan. As a student, I have found a lot of times you are correct and many times you are not. This is a processes that over time gets easier. In the ER I have found that you need to be quick, concise, and to the point otherwise the attending will lose interest or rush you to get to the point. Getting tips on this process is crucial! So far I have gotten only positive comments and constructive criticism. All of which have really helped me in the ER. For example, in primary care and in school I am used to using the head to toe approach. Meaning, when you present and when you do your physical exam on patients go from head to toe. In the ER, unless it is for a case that is pretty simple, I was told "go for the meat". Meaning, if someone comes in for back pain go straight to that when you are describing your physical findings, then go to other body systems.
       So, far I am enjoying my experience but I am not sure ER is for me. There is something about tracking a patient throughout their life and sharing that bond that primary care physicians have with their patients. In the meantime, I am getting the most out of my experience and enjoying the people I have met along the way.