For my Family Medicine rotation, I completed a site evaluation with my professor and one other student from my class, who was also rotating in Family Medicine, but at a different location. This made the evaluation and group discussion more interesting, since my classmate was at an office that dealt mostly with Worker’s Comp, while I was at a Family Medicine rotation in Far Rockaway, in the heart of a very underserved community. From my classmate I learned that the style of H&P writing at a Worker’s Comp office is slightly different, and that typically providers have to explain the level of injury. Through my presentation, I believe my classmate got to learn about the many comorbidities that patient’s from low income backgrounds suffer from, and the importance of patient education when discussing a treatment plan. For instance, aside from addressing the patient’s chief complaint, it was also important to discuss any screening tests that the patient was due for or never had, as well as education about smoking cessation for cigarette smokers, diet, and how to read nutrition facts on nutrition labels to help control hyperlipidemia, diabetes, and hypertension.

For my evaluation I prepared 2 full H&Ps, and presented one of those H&Ps, as well as 5 pharmacology cards and a journal article pertaining to my patient’s diagnosis/complaint. For my H&Ps, I chose two different types of cases: the first had a chief complaint of “difficulty swallowing” accompanied by unintentional weight loss along with other constitutional symptoms concerning for esophageal cancer, and the second was “lower back pain” from sciatica and a herniated nucleus pulposis. Since my classmate presented on a back pain patient first, I decided to present my first patient with dysphagia. Since all the patient’s signs and symptoms indicated a high likelihood of esophageal cancer, I discussed the need for a GI referral in my treatment plan, in order to obtain a barium swallow and endoscopy with esophageal biopsy to rule out cancer or other disorders. My site evaluator then asked if the provider and I ever followed up on the case, and I informed him that since we did routine bloodwork during the patient’s visit, the patient had returned to the office one week later to discuss her results. When reviewing the results we noticed abnormal liver function tests, specifically a high bilirubin of 5.0. My site evaluator then explained that elevated bilirubin is not just indicative of liver and/or biliary disease, but is also very concerning for malignancy and underlying ominous disease. I found this to be extremely helpful moving forward, especially when dealing with cases suspicious for cancer.

Overall, the site evaluation was very educational, in that I got to learn from my classmate and obtained helpful feedback from my site evaluator through my own presentation. I also liked that our site evaluator made sure to keep us engaged, by asking both me and my classmate various questions regardless who the presenter was. This helped me stay focused on my classmate’s presentation, and vise versa.