This past month I completed my Ambulatory Medicine rotation at Centers Urgent Care in Queens. Overall, it was an amazing learning experience that enabled me to utilize the knowledge I had gained from my inpatient rotations, while also having more opportunities to expand on my clinical skills. I also loved that the urgent care I was at had a very large and diverse patient volume, so I got to see over 100 patients a day, many of whom presented with interesting and unique complaints. For instance, although I assessed my fair share of “sore throat” and “runny nose” cases, I also evaluated patients for temporal arteritis, Bell’s palsy, Boxer’s fracture, animal bites, facial lacerations, pyelonephritis, and a wide range of other diagnoses that I had not yet seen in the hospital setting. I also enjoyed working with different providers everyday, many of whom were PAs and also one NP. In doing so, I was exposed to different styles and techniques of different providers, and was taught many tricks and pointers regarding suturing, digital blocks (injecting lidocaine to anesthetize a wounded digit), note taking, and patient interactions. For instance, I was taught by many providers to always have a list of differential diagnoses in the back of your head based on the patient’s chief complaint that is written in their chart before you even walk into the room and meet them. Doing this really helped me narrow down the important questions to ask, especially in more urgent situations when the patient was in a lot of pain, bleeding, suffering a possible stroke, or complaining of chest pain indicating possible MI. 

I also learned how to write a more focused H&P, which I was able to practice by typing up the H&Ps of every single patient I saw into their charts. In doing so, I not only learned how to narrow down my thought processes and think more critically, but I also became more comfortable with writing up notes. This was also a great way for me to learn how to present patients to my preceptors in a more concise way, so that I include all the pertinent and important information, without distracting my preceptor with extraneous details that are slightly less important. Although my presentation and write ups have definitely improved from presenting and writing H&Ps on about 100 patients per day, I also realized that there is still a lot more room for me to grow and expand on the skills I developed. I still need to practice formulating focused HPIs, performing focused but sufficient physical exams, creating a good differential diagnosis, and most importantly formulating a treatment plan. The treatment plan, which included deciding on the treatment (e.g. antibiotics for cellulitis) as well as the specific medication (e.g. Keflex vs. Augmentin), was definitely the most challenging part of this experience. I learned that I need to brush up on my pharmacology, specifically antibiotics; and I also learned that many of that knowledge comes with experience, since at the end of the day providers choose between specific medications based on provider preference. 

Overall, this rotation was one of my favorite rotations in that I got a glimpse into what it feels like to be an autonomous provider who has the responsibility of seeing their own patients, but also gets to work collaboratively with medical doctors, nurses, nurse practitioners, and medical assistants. The rotation helped build my confidence by forcing me from day one to see patients on my own and make decisions on my own, with the help of another provider.