For my first site evaluation with Professor Mohamed, I submitted two H&Ps and presented one. One H&P was about a patient with the complaint of RUQ pain, and the plan was to rule out acute coronary syndrome, cholecystitis vs. cholelithiasis, among other less urgent differentials (e.g. GERD, gastritis). The second H&P, which I presented, was on a patient with left-sided pelvic pain and vaginal bleeding. The patient reported she took two at-home urine pregnancy tests which were both positive, and her urine-HCG in the hospital was positive as well. When I presented the case, along with my plan, I mentioned that the most urgent possible diagnosis to rule out was an ectopic pregnancy, and therefore a quantitative HCG and a transvaginal ultrasound were ordered. After presenting the case, Professor Mohamed mentioned that it would have been a good idea to include a type & screen in the list of labs to order in the plan. The reason for that it to confirm that the patient is not Rh negative, because if she was then she should be given Rhogam at that moment and any other time she may have vaginal bleeding during her pregnancy. This was just one example of how the Professor taught me to treat the patient and their current symptoms in addition to just assessing and ruling out the differential diagnoses. Sometimes, in constructing my plan, I get caught up on figuring out the different tests and imaging to order so that I could properly rule out a broad list of differential diagnoses, and in doing so, I forget to discuss actual treatments such as pain control. Moving forward, I will definitely make a conscious effort to include both a broad assessment and wide range of differential diagnoses and steps to ruling them out, as well as treating patient’s condition and symptoms.

During my site evaluation, I also obtained a lot of positive feedback, especially regarding my HPI and differential diagnosis. I think over the many rotations I’ve completed, I learned how to write a focused HPI that includes all the important details, and is written in a way that easy for the reader to follow without getting distracted by extraneous details. I also learned how to construct a wide differential diagnosis that prioritized the most likely and most urgent diagnoses first, which is something I had difficulty with in the past. Finally, I learned from my classmates too during my site evaluations. For this rotation I was in a group with two other students, and not only did I get to hear about the patients they saw, but I got to see how they organized their thought processes to come up with an assessment and plan. Although everyone has their own unique style for writing out their H&Ps, I felt we were all able to highlight the most important aspects of the cases we presented, and assess the most important problems/complaints. I especially found it helpful how Professor Mohamed would relate different aspects of the cases back to what we learned in our Emergency Medicine class, since reiterating something from a different angle definitely helps remember it. For the next rotations, and during my career as a PA, I will work hard to keep my thoughts organized and present my patients in a way that is easy for others to follow. I will also make sure to keep in mind a broad list of differential diagnoses while also narrowing down my plan to prioritize the most urgent concerns and the patients complaints.