Rotation Reflection

My fourth rotation was Long Term Care at Queens Hospital Center. Due to the restrictions with Geriatric clinic at QHC since COVID-19, I was placed in the medicine unit. This was my first inpatient rotation and so it brought a very new and different experience from my previous outpatient rotations.

I really enjoyed getting to follow patients and see their progression which I hadn’t gotten to see in an outpatient setting. It was so helpful to be part of a team of an attending, residents and medical students to be able to learn from everyone and their various styles, knowledge and experiences. Morning rounds was a great opportunity to learn about all the patients on the floor even if I didn’t see them myself. The attending expected the students to see the new patients, review their chart, see them and then present a formal H&P at rounds. This pushed me to work on my skills presenting an H&P, especially the HPI, and learning how to incorporate all the pertinent information from their chart including their ED course, potential ICU/step-down unit course and history. I felt more comfortable presenting in front of a group of an attending, residents and students than I thought I would and that comfort only grew with time and practice.

One of the few things I really worked on this rotation was seeing a patient, learning their history from both this admission and past admissions and creating a succinct, concise story to help paint the picture of the patient – who they are and their baseline, what their medical needs have been up until this point, what brought them in and how their comorbidities are playing into the story. I truly learned how to better understand the patient and their needs. I never had access to a patient’s chart in a hospital setting before and I loved getting to see what was done for the patient in various parts of the hospital for their complaints. Furthermore, I also really liked seeing what specialties were consulted and following and what they did or were doing for the patient. I was finally able to see all the intricacies that go into patient care in this setting.

An interesting case I saw was a patient who presented with systemic complaints of diarrhea, fever, sore throat, dry cough, fever and myalgias for 5 days. Upon first thought it seemed like a viral syndrome as he presented with mainly constitutional symptoms. 1 day after admission, an erythematous, maculopapular rash appeared on the patient’s face, chest and forearms. After further probing and a viral load test, it became clear that the patient was presenting with early HIV infection. After the confirmation of the diagnosis, I presented on early HIV infection and its presentation to our team. Our patient had presented with majority of the early symptoms though it wasn’t the top differential. It was eye-opening and an important reminder to keep a wide differential.

I assisted one of the second-year residents in performing a paracentesis to drain ascitic fluid in an alcoholic. The resident explained what she was doing and took us step by step. After inserting the catheter correctly, the fluid wasn’t draining easily. The resident had to call in the attending who told the resident she had set up everything correctly and the catheter must’ve been pushed up against the intestines which is why the fluid isn’t draining well. The resident had to remove it and begin again. It was a good lesson to see a highly competent, knowledgeable and experienced resident need to re-do a procedure, despite doing it correctly, and showed me that it’s okay to make a mistake or for something to go wrong.

One thing I’d like to focus on for my upcoming rotations is the assessment and plan portion of the H&P. In this past rotation I worked hard on my HPI and presentation skills and now I’m ready to focus more on what my differentials are and how I’m going to work-up/treat the patient. I gained a lot from my LTC rotation and am looking forward to my next one!

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